Individual
DR. MICHAEL J WIENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
921 STATE ST, NEW HAVEN, CT 06511-3926
(203) 865-2245
Mailing address
140 ALSTON AVE, NEW HAVEN, CT 06515-2002
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
008178
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008001172
—
CT
Enumeration date
01/29/2007
Last updated
05/05/2014
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