Provider Demographics
NPI:1851640726
Name:RAYMOND J WISE DENTISTRY PC
Entity Type:Organization
Organization Name:RAYMOND J WISE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-243-1222
Mailing Address - Street 1:31 PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-1727
Mailing Address - Country:US
Mailing Address - Phone:413-243-1222
Mailing Address - Fax:413-243-3915
Practice Address - Street 1:31 PARK PLZ
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-1727
Practice Address - Country:US
Practice Address - Phone:413-243-1222
Practice Address - Fax:413-243-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty