Provider Demographics
NPI:1619007408
Name:WEATHERHOLT, CAREY BLANCHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:BLANCHARD
Last Name:WEATHERHOLT
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 1:1600 WILLOW ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5106
Mailing Address - Country:US
Mailing Address - Phone:408-264-3133
Mailing Address - Fax:408-264-2312
Practice Address - Street 1:1600 WILLOW ST STE 150
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5106
Practice Address - Country:US
Practice Address - Phone:408-264-3133
Practice Address - Fax:408-264-2312
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice