Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 34447 | CA |
NPI | 1033387485 |
---|---|
Provider Name | Dr. Steven Robert Wynn |
First Address | Newport Beach, CA 92660-5505 |
Second Address | Newport Beach, CA 92660-5505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2008 |
Last Update Date | 19/02/2008 |