Healthcare Provider Details

I. General information

NPI: 1326201005
Provider Name (Legal Business Name): ADAM WEISS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 PROSPECT ST
AMSTERDAM NY
12010-3614
US

IV. Provider business mailing address

37 PROSPECT ST
AMSTERDAM NY
12010-3614
US

V. Phone/Fax

Practice location:
  • Phone: 518-514-3983
  • Fax: 518-203-5108
Mailing address:
  • Phone: 518-514-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number054496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: