Provider Demographics
NPI:1033192398
Name:WEIS, MORGAN TREY (DDS)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:TREY
Last Name:WEIS
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 1:5915 HIGH ST W
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4505
Mailing Address - Country:US
Mailing Address - Phone:757-484-8262
Mailing Address - Fax:757-484-8262
Practice Address - Street 1:5915 HIGH ST W
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4505
Practice Address - Country:US
Practice Address - Phone:757-484-8262
Practice Address - Fax:757-484-8262
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510821223P0221X
VA0401104961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA02532658Medicaid
NY02532658Medicaid