Provider Demographics
NPI:1861557225
Name:WYKE, JEANNINE E (D M D)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:E
Last Name:WYKE
Suffix:
Gender:F
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W UNION BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3700
Mailing Address - Country:US
Mailing Address - Phone:610-867-1511
Mailing Address - Fax:610-867-7223
Practice Address - Street 1:701 W UNION BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3700
Practice Address - Country:US
Practice Address - Phone:610-867-1511
Practice Address - Fax:610-867-7223
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030557-L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry