Individual
COLLEEN MARIE WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
14690 NW 151ST BLVD # 20, ALACHUA, FL 32615-5328
(386) 462-1771
Mailing address
14690 NW 151ST BLVD # 20, ALACHUA, FL 32615-5328
(386) 462-1771
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN25264
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
FL
Other
Enumeration date
04/06/2020
Last updated
10/07/2022
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