Individual
DR. BRIAN A. WIEDEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
86-260 FARRINGTON HWY, WAIANAE, HI 96792-3128
(808) 697-3496
Mailing address
86-260 FARRINGTON HWY, WAIANAE, HI 96792-3128
(808) 697-3496
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901019234
MI
1223G0001X
General Practice Dentistry
CSDT-38
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19234-MI
DELTA DENTAL
MI
05
—
4823188
—
MI
Enumeration date
08/18/2006
Last updated
05/15/2010
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