Healthcare Provider Details

I. General information

NPI: 1710120225
Provider Name (Legal Business Name): JOHN E WEISE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E RIDGEWOOD AVE
RIDGEWOOD NJ
07450-3957
US

IV. Provider business mailing address

548 COVINGTON PL
WYCKOFF NJ
07481-1349
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-4404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22D1007546400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: