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General NPI Number Information
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NPI Number | 1619356672
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Entity Type | Individual
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Provider Name | STEVEN JOHN WIEMER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2015
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 3711 38TH STREET
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City | COLUMBUS
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State | NE
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Zip | 68601
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Country | US
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Telephone | 402-327-9400
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Fax | 402-327-9401
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-284-2511
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D13863
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 65958
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | R622
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7212
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License Number State | NE
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