Individual
DIANE RENEE WEIDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
HWY 264, MPP 388, POLACCA, AZ 86042
(928) 737-6169
(928) 737-6168
Mailing address
HWY 264, MPP 388, P.O. BOX 4000, POLACCA, AZ 86042
(928) 737-6169
(928) 737-6168
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH16244
FL
Other
Enumeration date
07/06/2009
Last updated
07/06/2009
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