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General NPI Number Information
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NPI Number | 1093609133
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Entity Type | Individual
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Provider Name | SYDNIE WEIS
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Gender | Female
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1177 S WATSON RD STE 107
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City | BUCKEYE
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State | AZ
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Zip | 85326-3465
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Country | US
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Telephone | 623-244-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 W BEARDSLEY RD UNIT 821
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City | GLENDALE
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State | AZ
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Zip | 85308-5697
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Country | US
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Telephone | 815-999-2038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D012501
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License Number State | AZ
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