David D. Wyse, D.d.s., P.c.
NPI #1124143896 in Bloomington, Illinois
Provider Information
- NPI Number
- 1124143896
- Entity Type
- Organization
- Organization Name
- David D. Wyse, D.d.s., P.c.
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Mar 20, 2007
- Last Updated
- Oct 3, 2013
Practice Location
- Address
- 207 S PROSPECT RD
- Address 2
- STE. 2
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-4905
- Phone
- (309) 663-6393
Authorized Official
- Name
- DR. DAVID D. WYSE, DDS
- Title
- OWNER
- Phone
- (309) 663-6393
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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