Provider Demographics
NPI:1033108279
Name:WEISS, DENNIS D (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:D
Last Name:WEISS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 W CENTER RD
Mailing Address - Street 2:STE #334
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-330-3200
Mailing Address - Fax:402-330-1545
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:STE #334
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-330-3200
Practice Address - Fax:402-330-1545
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE41841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6203OtherBC/BS INS
NE468651OtherUNITED CONCORDIA INS
NE470593761-01Medicaid