Provider Demographics
NPI:1801891957
Name:WIESENTHAL, LEE A (DDS)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:WIESENTHAL
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 1:229 ATWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-4052
Mailing Address - Country:US
Mailing Address - Phone:412-664-4495
Mailing Address - Fax:412-682-5710
Practice Address - Street 1:229 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-4052
Practice Address - Country:US
Practice Address - Phone:412-664-4495
Practice Address - Fax:412-682-5710
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015278L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice