Healthcare Provider Details

I. General information

NPI: 1982383089
Provider Name (Legal Business Name): MARCIA WEILAND DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 WAITE ST STE 1
NORTH BEND OR
97459-1229
US

IV. Provider business mailing address

222 TONGASS DR
SITKA AK
99835-9416
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-6232
  • Fax:
Mailing address:
  • Phone: 907-364-4548
  • Fax: 907-966-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12141
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number212625
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: