Provider Demographics
NPI:1033499496
Name:WEIGLE, JACOB NICHOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:NICHOLAS
Last Name:WEIGLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 PERIMETER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4125
Mailing Address - Country:US
Mailing Address - Phone:502-548-0073
Mailing Address - Fax:
Practice Address - Street 1:620 PERIMETER DR STE 103
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4125
Practice Address - Country:US
Practice Address - Phone:859-268-7668
Practice Address - Fax:859-972-0772
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9048122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist