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Organization
WISDOM FAMILY DENTISTRY, P.A.
Active
Organization
WISDOM FAMILY DENTISTRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC J WISDOM DDS (OWNER)
(785) 632-2400
Entity
Organization
Contact information
Practice address
712 6TH ST, CLAY CENTER, KS 67432-2915
(785) 632-2400
(785) 632-5893
Mailing address
712 6TH ST, CLAY CENTER, KS 67432-2915
(785) 632-2400
(785) 632-5893
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5188A
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095990B
—
KS
Enumeration date
07/15/2006
Last updated
01/04/2017
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