Provider Demographics
NPI:1497849855
Name:WIEMERS, DELWIN DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELWIN
Middle Name:DEAN
Last Name:WIEMERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3529
Mailing Address - Country:US
Mailing Address - Phone:830-426-4342
Mailing Address - Fax:
Practice Address - Street 1:3010 AVE G
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861
Practice Address - Country:US
Practice Address - Phone:830-426-4342
Practice Address - Fax:830-426-4342
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice