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General NPI Number Information
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NPI Number | 1871725739
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Entity Type | Organization
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Legal Business Name | PAUL B. WIEGAND D.D.S., M.S.D.,PA
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 14801 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3708
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Country | US
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Telephone | 210-495-5437
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Fax | 210-495-3434
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Provider Business Mailing Address
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Address Line | 14801 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3708
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Country | US
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Telephone | 210-495-5437
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Fax | 210-495-3434
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PAUL B WIEGAND
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Credential | DDS
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Telephone | 210-495-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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