Individual
SUSAN LEA WIENAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDA, RDH
Contact information
Practice address
100 CROZERVILLE RD, ASTON, PA 19014-1444
(161) 045-9305
Mailing address
496 GATES ST, PHILADELPHIA, PA 19128-2507
(215) 219-6672
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
DH-010901-L
PA
124Q00000X
Dental Hygienist
Primary
PHDH000989
PA
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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