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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