Provider Demographics
NPI:1306181847
Name:DAVID S. WIENER D.D.S. & ROBERT L. WAGNER DMD P.LL.C.
Entity type:Organization
Organization Name:DAVID S. WIENER D.D.S. & ROBERT L. WAGNER DMD P.LL.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-265-3132
Mailing Address - Street 1:200 EAST MAIN ST.
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-265-3132
Mailing Address - Fax:631-265-3209
Practice Address - Street 1:200 EAST MAIN ST.
Practice Address - Street 2:SUITE 4E
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-3132
Practice Address - Fax:631-265-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty