Individual
NATHANIEL WIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
390 BERRY ST, #B, BROOKLYN, NY 11249-6084
(718) 218-7210
Mailing address
160 WILDACRE AVE, LAWRENCE, NY 11559-1413
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
058348
NY
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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