Healthcare Provider Details

I. General information

NPI: 1184710238
Provider Name (Legal Business Name): JAMES VANCE WEIMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N WATER ST
MASONTOWN PA
15461
US

IV. Provider business mailing address

115 N WATER ST
MASONTOWN PA
15461
US

V. Phone/Fax

Practice location:
  • Phone: 724-583-9075
  • Fax: 724-583-9788
Mailing address:
  • Phone: 724-583-9075
  • Fax: 724-583-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS021706L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: