| David D. Wyse, D.D.S., P.C. | |
|
207 S Prospect Rd Ste. 2 Bloomington IL 61704-4905 | |
| (309) 663-6393 | |
| (309) 664-0366 |
| Full Name | David D. Wyse, D.D.S., P.C. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 207 S Prospect Rd, Bloomington, Illinois |
| Authorized Official Name and Position | David D. Wyse (OWNER) |
| Authorized Official Contact | 3096636393 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| David D. Wyse, D.D.S., P.C. 207 S Prospect Rd Ste. 2 Bloomington IL 61704-4905 Ph: (309) 663-6393 | David D. Wyse, D.D.S., P.C. 207 S Prospect Rd Ste. 2 Bloomington IL 61704-4905 Ph: (309) 663-6393 |
| NPI Number | 1124143896 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 10/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124143896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 060001892 (Illinois) | Primary |
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