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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