Provider Demographics
NPI:1679684732
Name:MICHAEL WIENER, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:MICHAEL WIENER, D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-226-1000
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-0130
Mailing Address - Country:US
Mailing Address - Phone:845-226-1000
Mailing Address - Fax:845-226-1004
Practice Address - Street 1:1007 ROUTE 82
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6165
Practice Address - Country:US
Practice Address - Phone:845-226-1000
Practice Address - Fax:845-226-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047467-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty