Provider Demographics
NPI:1437415973
Name:WEISS, NEIL E (MMD, PC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:E
Last Name:WEISS
Suffix:
Gender:M
Credentials:MMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E MARSHALL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4441
Mailing Address - Country:US
Mailing Address - Phone:610-692-3238
Mailing Address - Fax:610-429-3910
Practice Address - Street 1:600 E MARSHALL ST
Practice Address - Street 2:SUIYE 204
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4441
Practice Address - Country:US
Practice Address - Phone:610-692-3238
Practice Address - Fax:610-429-3910
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO18591L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist