Joel Gregory Wiersum SR., DDS

NPI #1467462341 in Kodiak, Alaska

Provider Information

NPI Number: 1467462341
Entity Type: Individual
Name: Joel Gregory Wiersum SR., DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Aug 9, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 411 REZANOF DR E
Address 2: SUITE 101
City: Kodiak
State: Alaska
ZIP Code: 99615
Phone: (907) 486-3475

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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