Most Relevant Information
Provider Data
| NPI Number: | 1003451642 |
| Provider Name: | BRIAN MATTHEW WIACEK DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 17917 |
Most Important Dates
| Enumeration Date: | 11/07/2019 |
| Last Updated: | 06/05/2023 |
Provider Practice Location
7115 GUILFORD DR STE 101
FREDERICK
MD
217045234
Practice Location Phone/Fax
| Phone: | 2403791550 |
| Fax: |
Provider Mailing Location
7115 GUILFORD DR STE 101
FREDERICK
MD
217045234
Provider Mailing Phone/Fax
| Phone: | 2403791550 |
| Fax: |