Provider Demographics
NPI:1073655593
Name:JEFFREY H. WEISS, D.D.S., P.C. DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:JEFFREY H. WEISS, D.D.S., P.C. DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-563-3400
Mailing Address - Street 1:22320 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2421
Mailing Address - Country:US
Mailing Address - Phone:313-563-3400
Mailing Address - Fax:313-563-7653
Practice Address - Street 1:22320 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2421
Practice Address - Country:US
Practice Address - Phone:313-563-3400
Practice Address - Fax:313-563-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011363261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental