Individual
MR. PHILIP JOSEPH WIEGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1714 WASHINGTON BLVD, EASTON, PA 18042
(610) 258-4379
(610) 258-3145
Mailing address
1714 WASHINGTON BLVD, EASTON, PA 18042
(610) 258-4379
(610) 258-3145
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DS018298L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0531603
MEDICAL ASSISTANCE
PA
Enumeration date
04/04/2007
Last updated
01/18/2011
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