Provider Demographics
NPI:1245254853
Name:WISLER, CRAIG A
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:WISLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3252
Mailing Address - Country:US
Mailing Address - Phone:765-573-6537
Mailing Address - Fax:765-382-0529
Practice Address - Street 1:2102 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3252
Practice Address - Country:US
Practice Address - Phone:765-573-6537
Practice Address - Fax:765-382-0529
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300108583Medicaid