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General NPI Number Information
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NPI Number | 1518410281
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Entity Type | Organization
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Legal Business Name | NATHANIEL WIEDER, DMD, P.C.
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 390 BERRY ST SUITE B
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City | BROOKLYN
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State | NY
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Zip | 11249-6084
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Country | US
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Telephone | 718-218-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 390 BERRY ST SUITE B
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City | BROOKLYN
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State | NY
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Zip | 11249-6084
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATHANIEL WIEDER
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Credential | D.M.D.
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Telephone | 516-316-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 058348-1
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License Number State | NY
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