Healthcare Provider Details

I. General information

NPI: 1942317813
Provider Name (Legal Business Name): MICHAEL WEISS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SOUTH CEDAR ST
HAZLETON PA
18201-6602
US

IV. Provider business mailing address

14 SOUTH CEDAR ST
HAZLETON PA
18201-6602
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-6275
  • Fax: 570-455-6276
Mailing address:
  • Phone: 570-455-6275
  • Fax: 570-455-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier006799
Identifier TypeOTHER
Identifier State
Identifier IssuerDORAL DENTAL
# 2
Identifier971440
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED CONCORDIA
# 3
Identifier68403
Identifier TypeOTHER
Identifier State
Identifier IssuerUNISON HEALTH PLAN

VIII. Authorized Official

Name: MICHAEL B WEISS
Title or Position: PRESIDENT
Credential: DDS
Phone: 570-455-6275