Individual
CODY MICHAEL WISNOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
650 W BALTIMORE ST, BALTIMORE, MD 21201-1510
(410) 706-7101
Mailing address
518 W FAYETTE ST # T1501B, BALTIMORE, MD 21201-6052
(443) 866-4402
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17703
MD
Other
Enumeration date
03/12/2022
Last updated
03/12/2022
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