MEDICARE: DR. DAVID BARRY WISS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10755	MI

General Provider Information

NPI Number	:	1740371574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BARRY WISS D.D.S.

Provider Business Mailing Address
First Line	:	18757 HURON RIVER DR
Second Line	:
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-9357
Country	:	US
Telephone Number	:	734-753-5000
Fax Number	:	734-753-5000

Provider Business Practice Location Address
First Line	:	18757 HURON RIVER DR
Second Line	:
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-9357
Country	:	US
Telephone Number	:	734-753-5000
Fax Number	:	734-753-5000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	12/15/2016

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