Individual
DR. JOHN DAVID WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
B 2817 REILLY RD, FORT BRAGG, NC 28310-7302
(910) 643-2196
Mailing address
B 2817 REILLY RD, FORT BRAGG, NC 28310-7302
(910) 643-2196
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4601
SC
1223G0001X
General Practice Dentistry
Primary
4601
SC
Other
Enumeration date
07/09/2009
Last updated
06/24/2013
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