Individual
DOMINIK WIETRZYNSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
11552 E 12 MILE RD, WARREN, MI 48093-2644
(586) 573-2533
Mailing address
11552 E 12 MILE RD, WARREN, MI 48093-2644
(586) 573-2533
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.028405
IL
122300000X
Dentist
Primary
2901020331
MI
Other
Enumeration date
07/14/2010
Last updated
09/08/2011
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