Individual
MRS. AMANDA KAY WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DA
Contact information
Practice address
9443 E 38TH ST, DENTAL CLINIC, INDIANAPOLIS, IN 46235-2132
(317) 890-2131
Mailing address
7392 PULLMAN CT, INDIANAPOLIS, IN 46256-3910
(317) 698-9791
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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