James R Wise, DDSMS
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Calimesa, CA
NPI 1609909308 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1609909308
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 19476 (CA)
- Practice address
- 1025 Calimesa Blvd
Ste. 2
Calimesa, CA 92320-1146 - Phone
- (909) 795-9707
- Fax
- (909) 795-7599
- NPI assigned
- Mar 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19476 | CA | MD | Acupuncturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 19476 | CA | Yes |
Addresses
Primary practice location
1025 Calimesa Blvd
Ste. 2
Calimesa, CA 92320-1146
Mailing address
1025 Calimesa Blvd
Ste. 2
Calimesa, CA 92320-1146
Phone (909) 795-9707
Other providers in Calimesa, CA
- Nhak Devean Vann
- Sarah Elizabeth Vanwaardenburg
- Walgreen Co
- Caroline Mumbi Wamuyu
- Brittney Williams
- Eliza M Zamora-Rada
All providers in Calimesa, CA · Orthodontics and Dentofacial Orthopedics Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.