Individual
DR. CHAD W WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30-022975
OH
1223G0001X
General Practice Dentistry
031655
PA
Other
Enumeration date
11/28/2006
Last updated
06/24/2009
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