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General NPI Number Information
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NPI Number | 1962993154
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Entity Type | Individual
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Provider Name | BETHANY THERESE WIERZBICKI D.M.D., M.B.A.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 3662 SW 30TH AVE STE 3
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City | PALM CITY
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State | FL
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Zip | 34990-3723
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Country | US
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Telephone | 772-217-5338
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Fax | 772-217-4599
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Provider Business Mailing Address
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Address Line | 3662 SW 30TH AVE STE 3
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City | PALM CITY
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State | FL
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Zip | 34990-3723
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Country | US
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Telephone | 772-217-5338
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Fax | 772-217-4599
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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 | DN23283
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License Number State | FL
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