Individual
KEVIN CHRISTOPHER WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2507 W CERMAK RD, SUITE 290, CHICAGO, IL 60608-3719
(773) 650-5100
Mailing address
2507 W CERMAK RD, SUITE 290, CHICAGO, IL 60608-3719
(773) 650-5100
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021002575
IL
Other
Enumeration date
03/01/2011
Last updated
05/04/2016
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