Individual
DR. THOMAS R WIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3707 WATSON RD, SAINT LOUIS, MO 63109-1236
(314) 645-6400
Mailing address
3707 WATSON RD, SAINT LOUIS, MO 63109-1236
(314) 645-6400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13165
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13165
STATE LICENSE
MO
Enumeration date
06/28/2005
Last updated
07/08/2007
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