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General NPI Number Information
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NPI Number | 1316478779
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Entity Type | Organization
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Legal Business Name | YOSEMITE DENTAL CARE, LLC
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 5371 STATE HIGHWAY 49 N
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City | MARIPOSA
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State | CA
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Zip | 95338-9503
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Country | US
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Telephone | 209-742-7788
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1209
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City | MARIPOSA
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State | CA
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Zip | 95338-1209
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Country | US
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Telephone | 209-742-7788
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | DR. TIMOTHY MICHAEL WIEG
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Credential | D.D.S.
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Telephone | 909-269-1277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60387
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License Number State | CA
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