Provider Demographics
NPI:1780317172
Name:WIER, MADISON MAIN (DMD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MAIN
Last Name:WIER
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 1:2030 CROSSINGS CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2779
Mailing Address - Country:US
Mailing Address - Phone:931-451-5550
Mailing Address - Fax:
Practice Address - Street 1:2030 CROSSINGS CIR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2779
Practice Address - Country:US
Practice Address - Phone:931-451-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist