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General NPI Number Information
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NPI Number | 1912121872
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Entity Type | Organization
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Legal Business Name | JOEL C WIECZOREK DDS PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 106 W BLACKWELL ST
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City | TULLAHOMA
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State | TN
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Zip | 37388
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Country | US
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Telephone | 931-461-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 106 W BLACKWELL ST
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City | TULLAHOMA
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State | TN
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Zip | 37388
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Country | US
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Telephone | 931-461-5533
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Fax |
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Authorized Official
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Title or Position | DENTIST PRESIDENT OF CORPORATION
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Name | DR. JOEL C WIECZOREK
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Credential | DDS
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Telephone | 931-461-5533
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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 | DS0000007411
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License Number State | TN
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