Provider Demographics
NPI:1538316856
Name:WEISS, PETER ALEXANDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALEXANDER
Last Name:WEISS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-731-8100
Mailing Address - Fax:617-731-8182
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-731-8100
Practice Address - Fax:617-731-8182
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8956122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8956OtherSTATE LICENSE