Provider Demographics
NPI:1265504476
Name:WEIS, BARTON DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARTON
Middle Name:DALE
Last Name:WEIS
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 1:1101 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5353
Mailing Address - Country:US
Mailing Address - Phone:434-971-9601
Mailing Address - Fax:434-971-9646
Practice Address - Street 1:1101 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5353
Practice Address - Country:US
Practice Address - Phone:434-971-9601
Practice Address - Fax:434-971-9646
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010085961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics