Provider Demographics
NPI:1689235954
Name:WEISZ, CRYSTAL C (RDH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:C
Last Name:WEISZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:C
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2111 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2529
Mailing Address - Country:US
Mailing Address - Phone:303-293-2220
Mailing Address - Fax:
Practice Address - Street 1:2130 STOUT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2827
Practice Address - Country:US
Practice Address - Phone:032-932-2203
Practice Address - Fax:303-296-8826
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002025526124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist