Healthcare Provider Details

I. General information

NPI: 1265456487
Provider Name (Legal Business Name): IRA HAROLD WEISS D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 ORANGE PL SUITE 100A
BEACHWOOD OH
44122-4426
US

IV. Provider business mailing address

3755 ORANGE PL SUITE 100A
BEACHWOOD OH
44122-4426
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-6340
  • Fax: 440-885-1911
Mailing address:
  • Phone: 216-292-6340
  • Fax: 440-885-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30016808
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: