Individual
MR. JOHN P WIEDERHOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3434 E. WASHINGTON AVE, MADISON, WI 53704-4155
(608) 443-5550
(608) 443-5554
Mailing address
2901 W. BELTLINE HWY., STE. 120, MADISON, WI 53713-4226
(608) 443-5500
(608) 441-1981
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
21644
MA
122300000X
Dentist
6263-015
WI
122300000X
Dentist
Primary
6263-15
WI
Other
Enumeration date
04/26/2007
Last updated
10/04/2011
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