Provider Demographics
NPI:1407036437
Name:JAMES L. WIELAND,D.D.S.,P.L.C.
Entity Type:Organization
Organization Name:JAMES L. WIELAND,D.D.S.,P.L.C.
Other - Org Name:NA
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:WIELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-241-2659
Mailing Address - Street 1:3167 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-1475
Mailing Address - Country:US
Mailing Address - Phone:616-241-2659
Mailing Address - Fax:616-241-0289
Practice Address - Street 1:3167 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1475
Practice Address - Country:US
Practice Address - Phone:616-241-2659
Practice Address - Fax:616-241-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011153261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental