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General NPI Number Information
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NPI Number | 1114621687
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Entity Type | Organization
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Legal Business Name | WISE OMFS
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 5750 BENTLEY WAY
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City | TRUSSVILLE
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State | AL
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Zip | 35173-6700
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Country | US
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Telephone | 205-665-5144
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Fax |
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Provider Business Mailing Address
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Address Line | 5750 BENTLEY WAY
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City | TRUSSVILLE
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State | AL
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Zip | 35173-6700
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Country | US
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Telephone | 205-900-9473
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Fax |
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Authorized Official
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Title or Position | CLINICAL OPS & BUSINESS DEVELOPMENT
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Name | DHARTI PATEL
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Credential |
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Telephone | 973-722-3327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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