Provider Demographics
NPI:1932116704
Name:BLISS-WEICK, MONICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:BLISS-WEICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 W HILLSBORO BLVD
Mailing Address - Street 2:C/D
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9426
Mailing Address - Country:US
Mailing Address - Phone:954-418-7970
Mailing Address - Fax:954-418-7971
Practice Address - Street 1:3656 W HILLSBORO BLVD
Practice Address - Street 2:C/D
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9426
Practice Address - Country:US
Practice Address - Phone:954-418-7970
Practice Address - Fax:954-418-7971
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist