Healthcare Provider Details

I. General information

NPI: 1437301595
Provider Name (Legal Business Name): JOSHUA L. WIELAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NE 3RD AVE
CANBY OR
97013
US

IV. Provider business mailing address

150 NE 3RD AVE.
CANBY OR
97013
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-2629
  • Fax: 503-266-2625
Mailing address:
  • Phone: 503-266-2629
  • Fax: 503-266-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7842
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7842
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: