Healthcare Provider Details

I. General information

NPI: 1821168469
Provider Name (Legal Business Name): JAMES FREDERICK WEIGAND D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 MAINE ST
POLAND SPRING ME
04274-5109
US

IV. Provider business mailing address

150 BEECH HILL RD
AUBURN ME
04210-8827
US

V. Phone/Fax

Practice location:
  • Phone: 207-998-4587
  • Fax: 207-998-5354
Mailing address:
  • Phone: 207-777-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3518
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: