Provider Demographics
NPI:1356449797
Name:WISEMAN, CARTER WILLIAM (DDS)
Entity Type:Individual
Prefix:MR
First Name:CARTER
Middle Name:WILLIAM
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:330 LINVILLE ST
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657
Mailing Address - Country:US
Mailing Address - Phone:828-733-5442
Mailing Address - Fax:828-733-0777
Practice Address - Street 1:330 LINVILLE ST
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657
Practice Address - Country:US
Practice Address - Phone:828-733-5442
Practice Address - Fax:828-733-8777
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999635Medicaid