Provider Demographics
NPI:1639238892
Name:WEYRAUCH, CURTIS DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:DEAN
Last Name:WEYRAUCH
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 1:1099 MOORE LAKE E DR
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5153
Mailing Address - Country:US
Mailing Address - Phone:763-586-9988
Mailing Address - Fax:
Practice Address - Street 1:1099 EAST MOORE LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-586-9988
Practice Address - Fax:763-586-9977
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND90151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice