Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
PROF. SAM WISE, DDS, MOM, MSC, MDS
Active Sole ProprietorPROF. SAM WISE, DDS, MOM, MSC, MDS is a 1223X2210X healthcare provider located in ROCKWALL, Texas. NPI 1417416728 is currently active in the NPPES registry. Verify at CMS.
1223X2210X · ROCKWALL, TX
Registration Details
- NPI Number
- 1417416728
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 16, 2019 (7.4284359071943 yrs)
- Last Updated
- Jan 9, 2023
- Licenses
-
35081 (TX)60795714 (WA)35081 (TX)35081 (TX)35081 (TX)
- Sole Proprietor
- Yes
Practice Information
- Address
-
3045 N GOLIAD ST STE 105ROCKWALL, TX, 750877097Browse TX providers · Browse ZIP 75087
- Phone
- 9727229100
- Primary Specialty
-
1223X2210X
1223X2210X
- Additional Specialty
- General Dentistry
- Additional Specialty
- General Dentistry
- Additional Specialty
- Oral & Maxillofacial Surgery
- Additional Specialty
- 1223X2210X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.