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General NPI Number Information
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NPI Number | 1306181847
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Entity Type | Organization
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Legal Business Name | DAVID S. WIENER D.D.S. & ROBERT L. WAGNER DMD P.LL.C.
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 200 EAST MAIN ST. SUITE 4E
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-265-3132
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Fax | 631-265-3209
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Provider Business Mailing Address
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Address Line | 200 EAST MAIN ST. SUITE 4E
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-265-3132
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Fax | 631-265-3209
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Authorized Official
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Title or Position | DR./PARTNER
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Name | DR. DAVID STEVEN WIENER
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Credential | DDS.
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Telephone | 631-265-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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