Provider Demographics
NPI:1710916606
Name:ALLAN D WEIMER DDS MS PC
Entity Type:Organization
Organization Name:ALLAN D WEIMER DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:970-879-4290
Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-5012
Mailing Address - Country:US
Mailing Address - Phone:970-879-4290
Mailing Address - Fax:970-879-6481
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-5012
Practice Address - Country:US
Practice Address - Phone:970-879-4290
Practice Address - Fax:970-879-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11829567Medicaid