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General NPI Number Information
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NPI Number | 1942127428
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Entity Type | Organization
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Legal Business Name | WISDOM TOOTH CLINICAL SERVICES PA
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Dates
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Enumeration Date | 07/03/2026
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Last Update Date | 07/03/2026
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Provider Practice Location Address
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Address Line | 100 NW 170TH ST STE 306
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-5511
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Country | US
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Telephone | 305-432-6719
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Fax |
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Provider Business Mailing Address
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Address Line | 304 INDIAN TRCE STE 905
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City | WESTON
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State | FL
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Zip | 33326-2996
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Country | US
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Telephone | 305-432-6719
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | DR. PETER CUDJOE
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Credential | DDS
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Telephone | 305-432-6719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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