Provider Demographics
NPI:1356346613
Name:WEIL, THOMAS MAURICE (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MAURICE
Last Name:WEIL
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 1:5066 FIELDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-2410
Mailing Address - Country:US
Mailing Address - Phone:713-961-1440
Mailing Address - Fax:713-961-0929
Practice Address - Street 1:2450 FONDREN RD
Practice Address - Street 2:STE 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2320
Practice Address - Country:US
Practice Address - Phone:713-783-5560
Practice Address - Fax:713-783-7333
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7991204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00L807Medicare ID - Type Unspecified
T16532Medicare UPIN