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Organization
DAVID D. WYSE, D.D.S., P.C.
Active
Organization
DAVID D. WYSE, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID D. WYSE DDS (OWNER)
(309) 663-6393
Entity
Organization
Contact information
Practice address
207 S PROSPECT RD, STE. 2, BLOOMINGTON, IL 61704-4905
(309) 663-6393
(309) 664-0366
Mailing address
207 S PROSPECT RD, STE. 2, BLOOMINGTON, IL 61704-4905
(309) 663-6393
(309) 664-0366
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
060001892
IL
Other
Enumeration date
03/20/2007
Last updated
10/03/2013
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