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General NPI Number Information
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NPI Number | 1407036437
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Entity Type | Organization
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Legal Business Name | JAMES L. WIELAND,D.D.S.,P.L.C.
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 3167 KALAMAZOO AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-1475
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Country | US
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Telephone | 616-241-2659
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Fax | 616-241-0289
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Provider Business Mailing Address
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Address Line | 3167 KALAMAZOO AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-1475
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Country | US
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Telephone | 616-241-2659
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Fax | 616-241-0289
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAMES LOUIS WIELAND
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Credential | D.D.S.
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Telephone | 616-241-2659
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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 | 2901011153
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License Number State | MI
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