Provider Demographics
NPI:1619539384
Name:JACOB D. WEISSICH, DDS, INC.
Entity Type:Organization
Organization Name:JACOB D. WEISSICH, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISSICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-431-9104
Mailing Address - Street 1:7730 N FRESNO ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2408
Mailing Address - Country:US
Mailing Address - Phone:917-536-1011
Mailing Address - Fax:
Practice Address - Street 1:7730 N FRESNO ST STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2408
Practice Address - Country:US
Practice Address - Phone:917-536-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental