Provider Demographics
NPI:1184714529
Name:WIERS, ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:WIERS
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 1:3739 N PINE GROVE AVE
Mailing Address - Street 2:#G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3739 N PINE GROVE AVE
Practice Address - Street 2:#G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4176
Practice Address - Country:US
Practice Address - Phone:608-395-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6057-151223G0001X
OH2562-RESIDENT1223G0001X
IL019.0278141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice