Healthcare Provider Details

I. General information

NPI: 1013657063
Provider Name (Legal Business Name): RAMKISSOON WEISS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 SW BENTLEY PL
LAKE CITY FL
32025-6972
US

IV. Provider business mailing address

272 SW BENTLEY PL
LAKE CITY FL
32025-6972
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-3043
  • Fax: 386-755-1466
Mailing address:
  • Phone: 386-752-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHANN RAMKISSOON
Title or Position: MANAGER
Credential: DMD
Phone: 386-752-3043