Provider Demographics
NPI:1942260252
Name:WIEMAN, WESLEY B
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:B
Last Name:WIEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 HARRIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4807
Mailing Address - Country:US
Mailing Address - Phone:707-443-6781
Mailing Address - Fax:707-443-6719
Practice Address - Street 1:2787 HARRIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4807
Practice Address - Country:US
Practice Address - Phone:707-443-6781
Practice Address - Fax:707-443-6719
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry