Healthcare Provider Details

I. General information

NPI: 1790872042
Provider Name (Legal Business Name): JEFFREY A WEISS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 NW 67 AVE #110
MIAMI LAKES FL
33014
US

IV. Provider business mailing address

15102 SW 38TH ST
DAVIE FL
33331
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-8831
  • Fax:
Mailing address:
  • Phone: 954-236-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN15340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: