Provider Demographics
NPI:1942428859
Name:WISE, JOHN B (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:WISE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:6960 PARKWOOD BLVD
Mailing Address - Street 2:#100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-712-6862
Mailing Address - Fax:972-377-9559
Practice Address - Street 1:6960 PARKWOOD BLVD
Practice Address - Street 2:#100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-712-6862
Practice Address - Fax:972-377-9559
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX15549TX1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics