Provider Demographics
NPI:1447484787
Name:WIETECHA, HANNA (LD)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:WIETECHA
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 127TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2242
Mailing Address - Country:US
Mailing Address - Phone:425-681-4277
Mailing Address - Fax:
Practice Address - Street 1:13810 127TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2242
Practice Address - Country:US
Practice Address - Phone:425-681-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60074145122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist