Provider Demographics
NPI:1629159082
Name:WEILAND, ALAN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:WEILAND
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:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-0384
Mailing Address - Country:US
Mailing Address - Phone:863-227-1631
Mailing Address - Fax:
Practice Address - Street 1:316 E TRINIDAD AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3830
Practice Address - Country:US
Practice Address - Phone:863-227-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice