Individual
DR. LARRY A WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
909 W ESPLANADE AVE, SUITE 101, KENNER, LA 70065-2700
(504) 464-0202
(504) 464-0264
Mailing address
909 W ESPLANADE AVE, SUITE 101, KENNER, LA 70065-2700
(504) 464-0202
(504) 464-0264
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2777
LA
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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