Provider Demographics
NPI:1598921090
Name:WIESEMAN, CHRISTOPHER R J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R J
Last Name:WIESEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1303 ANDREWS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2747
Mailing Address - Country:US
Mailing Address - Phone:402-370-3900
Mailing Address - Fax:402-370-3901
Practice Address - Street 1:1303 ANDREWS DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2747
Practice Address - Country:US
Practice Address - Phone:402-370-3900
Practice Address - Fax:402-370-3901
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE67761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics