Provider Demographics
NPI:1689829244
Name:WIEBE, AMBER (DMD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:WIEBE
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 1:4942 US HIGHWAY 98 W
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4091
Mailing Address - Country:US
Mailing Address - Phone:850-267-0777
Mailing Address - Fax:
Practice Address - Street 1:4942 US HIGHWAY 98 W
Practice Address - Street 2:SUITE 19
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-4091
Practice Address - Country:US
Practice Address - Phone:850-267-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice