Provider Demographics
NPI:1073904470
Name:NICK WEISS DDS LLC
Entity Type:Organization
Organization Name:NICK WEISS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-227-1348
Mailing Address - Street 1:2801 E CAROWINDS CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9716
Mailing Address - Country:US
Mailing Address - Phone:262-227-1348
Mailing Address - Fax:
Practice Address - Street 1:2801 E CAROWINDS CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-9716
Practice Address - Country:US
Practice Address - Phone:262-227-1348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011545A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental