# TESLA DENTAL IMPLANT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487398285
- **Authorized official:** PROF. SAM WISE DDS, MOM, MSC, MDS (OWNER)
- **Authorized official phone:** (973) 747-6425

## Contact information

- **Practice address:** 151 RIDGE POINT PKWY STE 400, KELLER, TX 76248-8801
- **Practice address phone:** (817) 835-6955
- **Mailing address:** 5605 FM 423, SUIT 500 \#410, FRISCO, TX 75036
- **Mailing address phone:** (973) 747-6425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223X2210X | Orofacial Pain Dentistry | — | NULL | Yes |
| 1223X2210X | Orofacial Pain Dentistry | — | — | Yes |
| 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