Provider Demographics
NPI:1053813907
Name:WEIGHTMAN, BAILEY KATE (DDS)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:KATE
Last Name:WEIGHTMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8451
Mailing Address - Country:US
Mailing Address - Phone:843-899-7668
Mailing Address - Fax:
Practice Address - Street 1:2900 N MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8451
Practice Address - Country:US
Practice Address - Phone:843-899-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
SC102761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program