# DR. RICHARD WILLIAM WIEDEMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1528102027
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2015018392 | MO | — |
| 1223G0001X | General Practice Dentistry | 7085 | NC | Yes |

## Other

- **Enumeration date:** 02/16/2007
- **Last updated:** 05/01/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 89012MJ | — | NC |