Provider Demographics
NPI:1265445688
Name:WEITZEL, PAMELA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LYNN
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONTOOCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03229
Mailing Address - Country:US
Mailing Address - Phone:603-746-4674
Mailing Address - Fax:603-746-4674
Practice Address - Street 1:656 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONTOOCOOK
Practice Address - State:NH
Practice Address - Zip Code:03229
Practice Address - Country:US
Practice Address - Phone:603-746-4674
Practice Address - Fax:603-746-4099
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002797Medicaid