Provider Demographics
NPI:1609161157
Name:WEILACHER, JASON M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:WEILACHER
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 1:3520 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1505
Mailing Address - Country:US
Mailing Address - Phone:918-742-2488
Mailing Address - Fax:918-742-4875
Practice Address - Street 1:3520 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1505
Practice Address - Country:US
Practice Address - Phone:918-742-2488
Practice Address - Fax:918-742-4875
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist