Provider Demographics
NPI:1285180869
Name:WEGIEL, BARBARA (DMD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:WEGIEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 NEELY RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99073
Mailing Address - Country:US
Mailing Address - Phone:773-552-9154
Mailing Address - Fax:
Practice Address - Street 1:FORT BRAGG DENTAC
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:773-552-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030736122300000X
IL0190307361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist