Organization
WISWALL ENDODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW T WISWALL DDS (PRESIDENT)
(605) 789-2017
Entity
Organization
Contact information
Practice address
2333 W 57TH ST, STE 103, SIOUX FALLS, SD 57108-5053
(605) 789-2017
Mailing address
2333 W 57TH ST, STE 103, SIOUX FALLS, SD 57108-5053
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D0827
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255656807
NPI
SD
Enumeration date
12/04/2014
Last updated
12/04/2014
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