Individual
CAROL WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
700 SHERIDAN LAKE RD., RAPID CITY, SD 57702
(605) 721-6634
(605) 341-5757
Mailing address
700 SHERIDAN LAKE RD, RAPID CITY, SD 57702-2407
(605) 721-6634
(605) 341-5757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901020964
MI
1223P0221X
Pediatric Dentistry
Primary
D1361
SD
Other
Enumeration date
05/30/2013
Last updated
09/21/2022
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