Provider Demographics
NPI:1225242514
Name:WEI, MICHAEL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:WEI
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 1:66 TERHUNE AVE
Mailing Address - Street 2:UNIT #10
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-5102
Mailing Address - Country:US
Mailing Address - Phone:917-886-4259
Mailing Address - Fax:
Practice Address - Street 1:29 W 57TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3406
Practice Address - Country:US
Practice Address - Phone:212-982-4080
Practice Address - Fax:212-935-4703
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049284-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice