Healthcare Provider Details

I. General information

NPI: 1134725633
Provider Name (Legal Business Name): C. MICHAEL WISE D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E MARKET AVE
SEARCY AR
72143-5429
US

IV. Provider business mailing address

333 E MARKET AVE
SEARCY AR
72143-5429
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-8634
  • Fax: 501-268-8652
Mailing address:
  • Phone: 501-268-8634
  • Fax: 501-268-8652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES M WISE
Title or Position: DDS
Credential: DDS
Phone: 501-268-8634