Individual
CHARLES WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2509 PICO BLVD, SANTA MONICA, CA 90405-1828
(310) 392-8636
Mailing address
2509 PICO BLVD, SANTA MONICA, CA 90405-1828
(310) 392-8636
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
26245
CA
1223G0001X
General Practice Dentistry
Primary
26245
CA
Other
Enumeration date
03/18/2014
Last updated
02/18/2021
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