Healthcare Provider Details

I. General information

NPI: 1942127428
Provider Name (Legal Business Name): WISDOM TOOTH CLINICAL SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST STE 306
NORTH MIAMI BEACH FL
33169-5511
US

IV. Provider business mailing address

304 INDIAN TRCE STE 905
WESTON FL
33326-2996
US

V. Phone/Fax

Practice location:
  • Phone: 305-432-6719
  • Fax:
Mailing address:
  • Phone: 305-432-6719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER CUDJOE
Title or Position: OPERATOR
Credential: DDS
Phone: 305-432-6719