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General NPI Number Information
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NPI Number | 1790845808
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Entity Type | Individual
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Provider Name | DARRIN MICHAEL WIEDERHOLD DMD MS
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 520 N 12TH ST 4TH FLOOR
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City | RICHMOND
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State | VA
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Zip | 23298-0566
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Country | US
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Telephone | 804-828-7752
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N 5TH ST APT 1017
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City | RICHMOND
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State | VA
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Zip | 23219-0013
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Country | US
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Telephone | 804-828-7752
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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 | DS036972
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401414219
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 55531
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE61306850
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License Number State | WA
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