Individual
MARIDEL WISEHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
213 CEDAR DR #C, PORTLAND, TX 78374
(361) 643-2522
(361) 643-1266
Mailing address
228 PECOS DR, PORTLAND, TX 78374
(361) 643-9699
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13559
TX
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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