Provider Demographics
NPI:1730324757
Name:WYATT, MELVA SOSA (DDS)
Entity type:Individual
Prefix:MRS
First Name:MELVA
Middle Name:SOSA
Last Name:WYATT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16646 QUAIL HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7440
Mailing Address - Country:US
Mailing Address - Phone:909-606-9700
Mailing Address - Fax:
Practice Address - Street 1:8004 HAVEN AVE
Practice Address - Street 2:STE. 100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3047
Practice Address - Country:US
Practice Address - Phone:909-483-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist