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NPI Code Detail

MEDICARE: DR. LUCAS JAMES WIEBE D.D.S

MEDICARE: DR. LUCAS JAMES WIEBE D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry606SD

General Provider Information

NPI Number : 1710335708
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUCAS JAMES WIEBE D.D.S
Provider Business Mailing Address
First Line : PO BOX 9
Second Line :
City : CANTON
State : SD
Zip : 57013-0009
Country : US
Telephone Number : 605-987-2721
Fax Number : 605-987-3312
Provider Business Practice Location Address
First Line : 1110 W 5TH ST
Second Line :
City : CANTON
State : SD
Zip : 57013-1543
Country : US
Telephone Number : 605-987-2721
Fax Number : 605-987-3312
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2016
Last Update Date : 05/31/2016

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