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NPI Code Detail

MEDICARE: MRS. AMANDA KAY WISEMAN DA

MEDICARE: MRS. AMANDA KAY WISEMAN DA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1126800000XDental Assistant

General Provider Information

NPI Number : 1568542868
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA KAY WISEMAN DA
Provider Business Mailing Address
First Line : 7392 PULLMAN CT
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-3910
Country : US
Telephone Number : 317-698-9791
Fax Number :
Provider Business Practice Location Address
First Line : 9443 E 38TH ST
Second Line : DENTAL CLINIC
City : INDIANAPOLIS
State : IN
Zip : 46235-2132
Country : US
Telephone Number : 317-890-2131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. AMANDA KAY WISEMAN DA” Practice Location

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