Provider Demographics
NPI:1902990203
Name:WIEBER, HOLLY T (DDS)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:T
Last Name:WIEBER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 TELEGRAPH AVE
Mailing Address - Street 2:#300
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-3629
Mailing Address - Country:US
Mailing Address - Phone:510-549-2814
Mailing Address - Fax:510-849-1511
Practice Address - Street 1:3017 TELEGRAPH AVE
Practice Address - Street 2:#300
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-3629
Practice Address - Country:US
Practice Address - Phone:510-549-2814
Practice Address - Fax:510-849-1511
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist