Individual
DR. KENNETH WIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3915 BROADWAY, NEW YORK, NY 10032-1565
(212) 567-5536
(212) 202-6447
Mailing address
3915 BROADWAY, NEW YORK, NY 10032-1565
(212) 567-5536
(212) 202-6447
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
055352-1
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DRP447
FL
Other
Enumeration date
12/08/2006
Last updated
12/13/2013
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