| NPI | 1558571315 |
|---|---|
| Other Name | JUDITH LORALE WIESNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 17125) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00202217) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-03-02 |