Provider Demographics
NPI:1790734275
Name:WEISMAN, HAROLD B (DMD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:B
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100A TRIANGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-2830
Mailing Address - Country:US
Mailing Address - Phone:704-392-7409
Mailing Address - Fax:701-392-1624
Practice Address - Street 1:4100A TRIANGLE DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2830
Practice Address - Country:US
Practice Address - Phone:704-392-7409
Practice Address - Fax:701-392-1624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999095Medicaid
NC99095OtherHEALTH CHOICE
454136OtherUNITED CONCORDIA