Individual
JONATHAN P WIENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MSD
Contact information
Practice address
6177 ORCHARD LAKE ROAD, SUITE 120, WEST BLOOMFIELD, MI 48322
(248) 855-6655
(248) 855-0803
Mailing address
6177 ORCHARD LAKE ROAD, SUITE #120, WEST BLOOMFIELD, MI 48322
(248) 855-6655
(248) 855-0803
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D10587
MI
1223P0700X
Prosthodontics
2901010587
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901010587
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901010587
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1940814
—
MI
Enumeration date
02/05/2007
Last updated
07/30/2012
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