MEDICARE: MR. DUSTIN FREDERICK WEITZ D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D13926	MN
2	1223E0200X	Endodontics	D-3556-EN	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952429946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUSTIN FREDERICK WEITZ D.D.S., M.S.

Provider Business Mailing Address
First Line	:	505 S MOUNTAIN VIEW RD STE 4
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-9205
Country	:	US
Telephone Number	:	208-882-2986
Fax Number	:	208-882-2987

Provider Business Practice Location Address
First Line	:	505 S MOUNTAIN VIEW RD STE 4
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-9205
Country	:	US
Telephone Number	:	208-882-2986
Fax Number	:	208-882-2987

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	10/03/2020

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Directions to “ MR. DUSTIN FREDERICK WEITZ D.D.S., M.S.” Practice Location

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