Individual
WISDOM OSISIOMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MPH
Contact information
Practice address
3700 N PRINCE ST, CLOVIS, NM 88101-2103
(575) 219-3040
Mailing address
3700 N PRINCE ST, CLOVIS, NM 88101-2103
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DB-2025-0140
NM
1223G0001X
General Practice Dentistry
DB-2025-0140
NM
Other
Enumeration date
01/01/2024
Last updated
07/25/2025
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