Provider Demographics
NPI:1326201005
Name:WEISS, ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:WEISS
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 1:37 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-3614
Mailing Address - Country:US
Mailing Address - Phone:518-514-3983
Mailing Address - Fax:
Practice Address - Street 1:37 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3614
Practice Address - Country:US
Practice Address - Phone:518-514-3983
Practice Address - Fax:518-203-5108
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0544961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03569835Medicaid