Wiedemann, Thomas R

Wiedemann, Thomas R is an individual health care provider with primary practice located at 3707 Watson Rd , Saint Louis MO 63109-1236. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Wiedemann, Thomas R can be contacted via phone (314) 645-6400.

Contact Information

Primary practice address
3707 Watson Rd Saint Louis MO 63109-1236
Phone: (314) 645-6400
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 13165 Missouri

Profile Details

NPI number 1790782399
LBN Legal business name Wiedemann, Thomas R
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790782399 NPPES
Missouri Other 13165 STATE LICENSE

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