Provider Demographics
NPI:1962993154
Name:WIERZBICKI, BETHANY THERESE (DMD, MBA)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:THERESE
Last Name:WIERZBICKI
Suffix:
Gender:
Credentials:DMD, MBA
Other - Prefix:DR
Other - First Name:BETHANY
Other - Middle Name:THERESE
Other - Last Name:BENIEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MBA
Mailing Address - Street 1:3662 SW 30TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3723
Mailing Address - Country:US
Mailing Address - Phone:772-217-5338
Mailing Address - Fax:772-217-4599
Practice Address - Street 1:3662 SW 30TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3723
Practice Address - Country:US
Practice Address - Phone:772-217-5338
Practice Address - Fax:772-217-4599
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1962993154OtherNPI