Provider Demographics
NPI:1114123882
Name:WEISS, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WEISS
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 1:445 N STATE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1417
Mailing Address - Country:US
Mailing Address - Phone:914-941-1890
Mailing Address - Fax:
Practice Address - Street 1:445 N STATE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF
Practice Address - State:NY
Practice Address - Zip Code:10510-1417
Practice Address - Country:US
Practice Address - Phone:914-941-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY418071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist