Provider Demographics
NPI:1609843697
Name:WEISS, DENTON DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DENTON
Middle Name:DEAN
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 BENDIX RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1367
Mailing Address - Country:US
Mailing Address - Phone:757-490-7545
Mailing Address - Fax:757-490-7549
Practice Address - Street 1:272 BENDIX RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1367
Practice Address - Country:US
Practice Address - Phone:757-490-7545
Practice Address - Fax:757-490-7549
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226095207YX0007X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7302834OtherAETNA
VA188308OtherANTHEM BC/BS VA
VA10004168OtherOPTIMA
VA41-2051174OtherCIGNA
VAH34087Medicare UPIN