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Individual

LAUREN WIESE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
957 ROUTE 33, HAMILTON SQUARE, NJ 08690
(609) 587-5858
Mailing address
3 ACORN HILL HOLW, VOORHEES, NJ 08043-1524
(609) 841-8121

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
12451
CT
122300000X
Dentist
16148
MD
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
026532
NJ
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
08/26/2016
Last updated
06/22/2019
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