Individual
DR. RICHARD WILLIAM WIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
15 JANE JACOBS RD STE 201, BLACK MOUNTAIN, NC 28711-6308
(828) 210-7051
(828) 210-7052
Mailing address
15 JANE JACOBS RD, SUITE 201, BLACK MOUNTAIN, NC 28711-6306
(828) 210-7051
(828) 210-7052
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2015018392
MO
1223G0001X
General Practice Dentistry
Primary
7085
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89012MJ
—
NC
Enumeration date
02/16/2007
Last updated
05/01/2018
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