Provider Demographics
NPI:1710010632
Name:RICHARD A. WEILER, JR., D.D.S. AND ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:RICHARD A. WEILER, JR., D.D.S. AND ASSOCIATES, P.C.
Other - Org Name:RICHARD A. WEILER, JR., DDS AND CHARLES S. WAIKLEY, D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-430-0505
Mailing Address - Street 1:527 LONG POND DR
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-1227
Mailing Address - Country:US
Mailing Address - Phone:508-430-0505
Mailing Address - Fax:508-430-0918
Practice Address - Street 1:527 LONG POND DR
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1227
Practice Address - Country:US
Practice Address - Phone:508-430-0505
Practice Address - Fax:508-430-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty