Provider Demographics
NPI:1861062762
Name:WISER, ADRIAN JACK (DMD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:JACK
Last Name:WISER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:RIFTON
Mailing Address - State:NY
Mailing Address - Zip Code:12471-7200
Mailing Address - Country:US
Mailing Address - Phone:917-580-2836
Mailing Address - Fax:
Practice Address - Street 1:105 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:RIFTON
Practice Address - State:NY
Practice Address - Zip Code:12471-7200
Practice Address - Country:US
Practice Address - Phone:917-580-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY062813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program