Organization
ERIC J. WISDOM D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC J WISDOM DDS (OWNER)
(785) 776-1771
Entity
Organization
Contact information
Practice address
1629 POYNTZ AVE, MANHATTAN, KS 66502-4148
(785) 776-1771
(785) 539-3905
Mailing address
1629 POYNTZ AVE, MANHATTAN, KS 66502-4148
(785) 776-1771
(785) 539-3905
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095990C
—
KS
Enumeration date
07/15/2006
Last updated
11/29/2012
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