Individual
DR. TODD SAMUEL WYSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
57250 ALPHA DR, GOSHEN, IN 46528-7804
(574) 875-3817
(574) 875-3984
Mailing address
57250 ALPHA DR, GOSHEN, IN 46528-7804
(574) 875-3817
(574) 875-3984
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008834
IN
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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