Individual
DR. JOHN D WIEBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4815 PAULSEN ST, SAVANNAH, GA 31405-4418
(912) 352-2324
(912) 354-0935
Mailing address
4815 PAULSEN ST, SAVANNAH, GA 31405-4418
(912) 352-2324
(912) 354-0935
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN009669
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02643168
—
GA
01
—
9183964
DORAL DENTAL MEDICAID
GA
01
—
ZZ9669
SOUTH CAROLINA
SC
Enumeration date
02/07/2007
Last updated
03/04/2009
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