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General NPI Number Information
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NPI Number | 1497869960
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Entity Type | Individual
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Provider Name | THOMAS GEORGE WIEG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 06/30/2015
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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 | 5371 HIGHWAY 49 NORTH P O BOX 1209
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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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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 | 28895
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License Number State | CA
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