Provider Demographics
NPI:1457573396
Name:WEITZEL, KENT CHARLES (DMD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:CHARLES
Last Name:WEITZEL
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 1:808 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-2626
Mailing Address - Country:US
Mailing Address - Phone:352-671-8077
Mailing Address - Fax:352-671-7339
Practice Address - Street 1:808 NW 35TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-2626
Practice Address - Country:US
Practice Address - Phone:352-671-8077
Practice Address - Fax:352-671-7339
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN90401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice