Brian Matthew Wiacek
Dentist - General Practice
20042 Eva St Ste 100
Montgomery
, Texas 77356-2042
Brian Matthew Wiacek
Dentist - General Practice
20042 Eva St Ste 100
Montgomery
, Texas 77356-2042
(936) 206-7069
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About
Features
Specialties
- General Practice
Languages spoken
- English
Location
First Address
- Brian Matthew Wiacek
- 20042 Eva St Ste 100
- Montgomery, TX
- Zip : 77356-2042
- Fax : (936) 206-7069
- Phone : (936) 206-7069
Second Address
- Brian Matthew Wiacek
- 20042 Eva St Ste 100
- Montgomery, TX
- Zip : 77356-2042
- Fax : (936) 206-7069
- Phone : (936) 206-7069
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223G0001X | General Practice | 35813 | TX |
| Y | 213EG0000X | General Practice | 35813 | TX |
National Provider Identifier
| NPI | 1003451642 |
|---|---|
| Provider Name | Brian Matthew Wiacek |
| First Address | Montgomery, TX 77356-2042 |
| Second Address | Montgomery, TX 77356-2042 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/11/2019 |
| Last Update Date | 07/11/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.