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Organization
TESLA DENTAL IMPLANT LLC
Active
Organization
TESLA DENTAL IMPLANT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. SAM WISE DDS, MOM, MSC, MDS (OWNER)
(973) 747-6425
Entity
Organization
Contact information
Practice address
151 RIDGE POINT PKWY STE 400, KELLER, TX 76248-8801
(817) 835-6955
Mailing address
5605 FM 423, SUIT 500 #410, FRISCO, TX 75036
(973) 747-6425
Taxonomy
Speciality
Code
Description
License number
State
1223X2210X
Orofacial Pain Dentistry
Primary
—
NULL
1223X2210X
Orofacial Pain Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
NULL
261QR0200X
Radiology Clinic/Center
—
NULL
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
NULL
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
NULL
292200000X
Dental Laboratory
—
NULL
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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