Provider Demographics
NPI:1356671481
Name:WIEBER, AMY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:WIEBER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N25W26378 WHITETAIL CT
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4574
Mailing Address - Country:US
Mailing Address - Phone:262-695-8363
Mailing Address - Fax:
Practice Address - Street 1:N25W26378 WHITETAIL CT
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-4574
Practice Address - Country:US
Practice Address - Phone:262-695-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4822-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist