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General NPI Number Information
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NPI Number | 1326423724
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Entity Type | Organization
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Legal Business Name | UNITED STATES AIR FORCE
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 2501 CAPEHART RD
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City | OFFUTT AFB
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State | NE
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Zip | 68113-1043
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Country | US
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Telephone | 402-232-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CAPEHART RD
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City | OFFUTT AFB
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State | NE
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Zip | 68113-1043
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Country | US
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Telephone | 402-232-2273
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KEVIN BRENT WIEST
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Credential | D.D.S.
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Telephone | 801-376-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 94297759922
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License Number State | UT
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