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Individual

DR. NICHOLAS WIESE

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
417 LINCOLN AVE NW, FARIBAULT, MN 55021-4952
(507) 332-7608
Mailing address
417 LINCOLN AVE NW, FARIBAULT, MN 55021-4952
(507) 332-7608

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11401
MN

Other

Enumeration date
10/13/2005
Last updated
07/08/2007
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