Provider Demographics
NPI:1790763076
Name:WEISS, ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:WEISS
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 1:123 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3222
Mailing Address - Country:US
Mailing Address - Phone:610-277-9811
Mailing Address - Fax:
Practice Address - Street 1:491 ALLENDALE RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1432
Practice Address - Country:US
Practice Address - Phone:610-265-3034
Practice Address - Fax:610-962-0192
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026236-L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics