Individual
MICHAEL THOMAS WIERNICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1074 SPRING LAKE PLAZA, WINTER HAVEN, FL 33881
(561) 289-4374
Mailing address
5717 TRACE MEADOW LOOP APT 304, RIVERVIEW, FL 33578-2625
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22302
FL
Other
Enumeration date
12/21/2018
Last updated
12/21/2018
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