Individual
DR. DAVID DOUGLAS WYSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
207 S PROSPECT RD, STE. 2, BLOOMINGTON, IL 61704-4905
(309) 663-6393
(309) 664-0366
Mailing address
207 S PROSPECT RD, STE. 2, BLOOMINGTON, IL 61704-4905
(309) 663-6393
(309) 664-0366
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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