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Individual
PROF. SAM WISE
Active
Individual
PROF. SAM WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MOM, MSC, MDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
35081
TX
1223G0001X
General Practice Dentistry
35081
TX
1223G0001X
General Practice Dentistry
60795714
WA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
35081
TX
1223X2210X
Orofacial Pain Dentistry
Primary
35081
TX
Other
Enumeration date
03/16/2019
Last updated
01/09/2023
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