Provider Demographics
NPI:1730138405
Name:WEITZ, ELIOT STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:STEVEN
Last Name:WEITZ
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 1:754 NEWBURY CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4552
Mailing Address - Country:US
Mailing Address - Phone:215-357-2833
Mailing Address - Fax:215-824-0366
Practice Address - Street 1:12401 ACADEMY RD
Practice Address - Street 2:SUITE # 214
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1932
Practice Address - Country:US
Practice Address - Phone:215-824-2762
Practice Address - Fax:215-824-0366
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023278L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice