Provider Demographics
NPI:1225318249
Name:WEATHERWAX, MAGARETTE (DDS)
Entity Type:Individual
Prefix:
First Name:MAGARETTE
Middle Name:
Last Name:WEATHERWAX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MAGARETTE
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5690 THREE NOTCH D RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3173
Mailing Address - Country:US
Mailing Address - Phone:434-823-4080
Mailing Address - Fax:
Practice Address - Street 1:5690 THREE NOTCH D RD STE 100
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3173
Practice Address - Country:US
Practice Address - Phone:434-823-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist