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General NPI Number Information
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NPI Number | 1902548068
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Entity Type | Organization
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Legal Business Name | DENTAL WISE PLLC
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 04/10/2022
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Provider Practice Location Address
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Address Line | 4001 E BROADWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85711-3454
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Country | US
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Telephone | 520-200-5023
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | CORTARO
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State | AZ
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Zip | 85652-0218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MANUEL RODRIGUEZ
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Credential | DMD
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Telephone | 520-256-3791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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