Provider Demographics
NPI:1275758302
Name:B HARVEY WIENER, DDS., PA
Entity Type:Organization
Organization Name:B HARVEY WIENER, DDS., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:B
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSCD, FRCD(C)
Authorized Official - Phone:954-463-9191
Mailing Address - Street 1:800 E BROWARD BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2008
Mailing Address - Country:US
Mailing Address - Phone:954-463-9191
Mailing Address - Fax:954-463-9194
Practice Address - Street 1:800 E BROWARD BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2008
Practice Address - Country:US
Practice Address - Phone:954-463-9191
Practice Address - Fax:954-463-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN76321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty