Provider Demographics
NPI:1225197387
Name:WEISS, THOMAS GARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GARY
Last Name:WEISS
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 1:88 CRANBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:410-666-9266
Mailing Address - Fax:410-666-9269
Practice Address - Street 1:88 CRANBROOK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030
Practice Address - Country:US
Practice Address - Phone:410-666-9266
Practice Address - Fax:410-666-9269
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice