Healthcare Provider Details

I. General information

NPI: 1033192398
Provider Name (Legal Business Name): MORGAN TREY WEIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 HIGH ST W
PORTSMOUTH VA
23703-4505
US

IV. Provider business mailing address

5915 HIGH ST W
PORTSMOUTH VA
23703-4505
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-8262
  • Fax: 757-484-8262
Mailing address:
  • Phone: 757-484-8262
  • Fax: 757-484-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number051082
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number040110496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: