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General NPI Number Information
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NPI Number | 1184714529
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Entity Type | Individual
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Provider Name | ANDREW WIERS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 3739 N PINE GROVE AVE #G
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City | CHICAGO
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State | IL
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Zip | 60613-4176
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Country | US
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Telephone | 608-395-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 3739 N PINE GROVE AVE #G
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City | CHICAGO
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State | IL
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Zip | 60613-4176
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6057-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2562-RESIDENT
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.027814
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License Number State | IL
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