Provider Demographics
NPI:1700269578
Name:WIESER, MARGARET B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:B
Last Name:WIESER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-1394
Mailing Address - Country:US
Mailing Address - Phone:608-882-4338
Mailing Address - Fax:
Practice Address - Street 1:449 S 1ST ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-1394
Practice Address - Country:US
Practice Address - Phone:608-882-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001161-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist