Individual
LAUREN WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
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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