Provider Demographics
NPI:1649942269
Name:WIESNER, ENOCH (DMD)
Entity type:Individual
Prefix:DR
First Name:ENOCH
Middle Name:
Last Name:WIESNER
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 1:34317 N CAVE CREEK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5137
Mailing Address - Country:US
Mailing Address - Phone:480-595-0800
Mailing Address - Fax:
Practice Address - Street 1:34317 N CAVE CREEK RD STE 103
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5137
Practice Address - Country:US
Practice Address - Phone:480-595-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0112031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice