Provider Demographics
NPI:1841932654
Name:WEIS, JAROD (DDS)
Entity type:Individual
Prefix:
First Name:JAROD
Middle Name:
Last Name:WEIS
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-5618
Mailing Address - Country:US
Mailing Address - Phone:843-475-5653
Mailing Address - Fax:
Practice Address - Street 1:548 RIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1600
Practice Address - Country:US
Practice Address - Phone:219-218-7235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX384791223G0001X
IL019.0346501223G0001X
IN12013950A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice