Provider Demographics
NPI:1700981826
Name:WYSE, MELVILLE CECIL (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:MELVILLE
Middle Name:CECIL
Last Name:WYSE
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6495 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3245
Mailing Address - Country:US
Mailing Address - Phone:301-270-2818
Mailing Address - Fax:301-270-9488
Practice Address - Street 1:6495 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3245
Practice Address - Country:US
Practice Address - Phone:301-270-2818
Practice Address - Fax:301-270-9488
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD070571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice