Individual
DR. DAVID PAUL WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
415 MORRIS ST STE 309, CHARLESTON, WV 25301-1853
(304) 388-3290
(304) 388-3186
Mailing address
415 MORRIS ST SUITE 309, CHARLESTON, WV 25301-1953
(304) 388-3290
(304) 388-3186
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
3328
WV
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
18520
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0047377-001
—
WV
05
—
0047377000
—
WV
01
—
850000198
RAILROAD MEDICARE
—
Enumeration date
04/14/2006
Last updated
06/20/2023
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