Provider Demographics
NPI:1871725739
Name:PAUL B. WIEGAND D.D.S., M.S.D.,PA
Entity type:Organization
Organization Name:PAUL B. WIEGAND D.D.S., M.S.D.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WIEGAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-495-5437
Mailing Address - Street 1:14801 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3708
Mailing Address - Country:US
Mailing Address - Phone:210-495-5437
Mailing Address - Fax:210-495-3434
Practice Address - Street 1:14801 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3708
Practice Address - Country:US
Practice Address - Phone:210-495-5437
Practice Address - Fax:210-495-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty