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General NPI Number Information
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NPI Number | 1225627532
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Entity Type | Individual
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Provider Name | CONOR M WIERUS DDS
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Gender | Male
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 9330 BEN C PRATT/6 MILE CYPRESS PKWY
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City | FORT MYERS
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State | FL
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Zip | 33966-6505
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Country | US
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Telephone | 239-337-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 9330 BEN C PRATT/6 MILE CYPRESS PKWY
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City | FORT MYERS
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State | FL
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Zip | 33966-6505
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Country | US
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Telephone | 239-337-1008
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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 | 019.032978
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN25773
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License Number State | FL
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