Individual
ERIC J WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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
5188
KS
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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