Provider Demographics
NPI:1033191812
Name:WEISMAN, MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9272 LAGUNA SPRINGS DR STE G2-327
Mailing Address - Street 2:CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7947
Mailing Address - Country:US
Mailing Address - Phone:916-691-0239
Mailing Address - Fax:
Practice Address - Street 1:9272 LAGUNA SPRINGS DR STE G2-327
Practice Address - Street 2:CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7947
Practice Address - Country:US
Practice Address - Phone:916-691-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice