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Organization
RICHARD W. WIEDEMAN, DDS, PA
Active
Organization
RICHARD W. WIEDEMAN, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WILLIAM WIEDEMAN D.D.S. (PRESIDENT)
(828) 210-7051
Entity
Organization
Contact information
Practice address
15 JANE JACOBS RD, SUITE 201, BLACK MOUNTAIN, NC 28711-6306
(828) 210-7051
(828) 210-7052
Mailing address
15 JANE JACOBS RD, SUITE 201, BLACK MOUNTAIN, NC 28711-6306
(828) 210-7051
(828) 210-7052
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
NC7085
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89012MJ
—
NC
Enumeration date
03/28/2008
Last updated
07/29/2013
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