Provider Demographics
NPI:1609909308
Name:WISE, JAMES R (DDSMS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:WISE
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
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Mailing Address - Street 1:1025 CALIMESA BLVD
Mailing Address - Street 2:STE. 2
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1146
Mailing Address - Country:US
Mailing Address - Phone:909-795-9707
Mailing Address - Fax:909-795-7599
Practice Address - Street 1:1025 CALIMESA BLVD
Practice Address - Street 2:STE. 2
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1146
Practice Address - Country:US
Practice Address - Phone:909-795-9707
Practice Address - Fax:909-795-7599
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA194761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics