Healthcare Provider Details

I. General information

NPI: 1124576723
Provider Name (Legal Business Name): ROBERT OLIVER WEISS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12184 NATURAL BRIDGE RD
BRIDGETON MO
63044-2017
US

IV. Provider business mailing address

9729 SAGAMORE RD
LEAWOOD KS
66206-2313
US

V. Phone/Fax

Practice location:
  • Phone: 314-391-4936
  • Fax:
Mailing address:
  • Phone: 314-609-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2023007573
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number62052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: