MEDICARE: DR. AMBER WIEBE DMD

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	DN15518	FL

General Provider Information

NPI Number	:	1689829244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER WIEBE DMD

Provider Business Mailing Address
First Line	:	4942 US HIGHWAY 98 W
Second Line	:	SUITE 19
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-4091
Country	:	US
Telephone Number	:	850-267-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4942 US HIGHWAY 98 W
Second Line	:	SUITE 19
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-4091
Country	:	US
Telephone Number	:	850-267-0777
Fax Number	:

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	11/24/2008

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