Provider Demographics
NPI:1639386477
Name:WIEMEYER, ANDREW (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WIEMEYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TREMONT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4751
Mailing Address - Country:US
Mailing Address - Phone:781-934-5292
Mailing Address - Fax:781-934-5511
Practice Address - Street 1:104 TREMONT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4751
Practice Address - Country:US
Practice Address - Phone:781-934-5292
Practice Address - Fax:781-934-5511
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics