Individual
DR. RYAN WIESEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
323 WEST DR, WHITE HOUSE, TN 37188-9294
(615) 325-4677
Mailing address
894 FRED LIVELY RD, BOWLING GREEN, KY 42104-7424
(615) 325-4677
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
8125
KY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8503
TN
Other
Enumeration date
01/04/2007
Last updated
05/31/2011
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