Provider Demographics
NPI:1619180841
Name:WEISS, MARILYN GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:GAIL
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 1:15217 8TH AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2566
Mailing Address - Country:US
Mailing Address - Phone:206-242-0920
Mailing Address - Fax:206-242-0987
Practice Address - Street 1:15217 8TH AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-2566
Practice Address - Country:US
Practice Address - Phone:206-242-0920
Practice Address - Fax:206-242-0987
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5003645Medicaid