Provider Demographics
NPI:1518933472
Name:WEISS, LOIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:L
Last Name:WEISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ALTA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1002
Mailing Address - Country:US
Mailing Address - Phone:631-476-2187
Mailing Address - Fax:718-463-6556
Practice Address - Street 1:19 ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1002
Practice Address - Country:US
Practice Address - Phone:631-476-2187
Practice Address - Fax:718-463-6556
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0350971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics