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General NPI Number Information
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NPI Number | 1710211388
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Entity Type | Individual
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Provider Name | PETER E. WIESEL DMD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 222 NEW ROAD SUITE #401
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City | LINWOOD
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State | NJ
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Zip | 08221
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Country | US
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Telephone | 609-927-5300
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Fax | 609-927-6731
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Provider Business Mailing Address
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Address Line | 222 NEW ROAD SUITE #401
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City | LINWOOD
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State | NJ
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Zip | 08221
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Country | US
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Telephone | 609-927-5300
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Fax | 609-927-6731
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DD101628200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 3554
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License Number State | NJ
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