Individual
DR. EDWARD M WISE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1090 RIBAUT RD, BEAUFORT, SC 29902-5437
(843) 521-4344
(843) 521-1804
Mailing address
1090 RIBAUT RD, BEAUFORT, SC 29902-5437
(843) 521-4344
(843) 521-1804
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
Z1777
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
826791
UCCI
—
05
—
Z17777
—
SC
Enumeration date
08/18/2006
Last updated
10/27/2010
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