Provider Demographics
NPI:1740381037
Name:WEIDMAN, ELLIOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:
Last Name:WEIDMAN
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 1:2226 W ATLANTIC AVE
Mailing Address - Street 2:SUITE W
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4637
Mailing Address - Country:US
Mailing Address - Phone:561-330-8330
Mailing Address - Fax:
Practice Address - Street 1:13889 WELLINGTON TRCE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-2121
Practice Address - Country:US
Practice Address - Phone:561-795-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics