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Organization
WISE OMFS
Active
Organization
WISE OMFS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DHARTI PATEL (CLINICAL OPS & BUSINESS DEVELOPMENT)
(973) 722-3327
Entity
Organization
Contact information
Practice address
711 KORNEGAY DR, PRATTVILLE, AL 36066-7715
(334) 285-7111
Mailing address
711 KORNEGAY DR, PRATTVILLE, AL 36066-7715
(334) 325-5810
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
05/06/2024
Last updated
09/10/2026
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