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General NPI Number Information
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NPI Number | 1760919849
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Entity Type | Individual
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Provider Name | NICHOLAS WEGNER DMD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 550 UNIVERSITY BLVD # UH-3143
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5149
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Country | US
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Telephone | 317-274-5315
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Fax |
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Provider Business Mailing Address
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Address Line | 105 BEN CASEY DR STE 115
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City | FORT MILL
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State | SC
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Zip | 29708-8557
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Country | US
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Telephone | 803-548-9910
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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 | 9832
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License Number State | SC
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