Individual
DR. BLAINE EDWARD WIECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2401 COMMERCE ST, AMARILLO, TX 79109-1513
(806) 358-7633
Mailing address
2401 COMMERCE ST, AMARILLO, TX 79109-1513
(806) 358-7633
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29187
TX
Other
Enumeration date
06/25/2013
Last updated
06/25/2013
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