Provider Demographics
NPI:1780384628
Name:WISE, MARGARET KATHRYN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:KATHRYN
Last Name:WISE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9532 GREAT SMOKEY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-4103
Mailing Address - Country:US
Mailing Address - Phone:262-853-8543
Mailing Address - Fax:
Practice Address - Street 1:2281 S RANGE AVE STE B
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5223
Practice Address - Country:US
Practice Address - Phone:225-664-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice