Healthcare Provider Details

I. General information

NPI: 1275320442
Provider Name (Legal Business Name): WIELAND ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ARCHER DR
EAST MOLINE IL
61244-3757
US

IV. Provider business mailing address

3800 ARCHER DR
EAST MOLINE IL
61244-3757
US

V. Phone/Fax

Practice location:
  • Phone: 309-721-2451
  • Fax:
Mailing address:
  • Phone: 309-721-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIGAIL MICHELE WIELAND
Title or Position: ORTHODONTIST
Credential: BA, DDS, MS
Phone: 309-721-2451