Provider Demographics
NPI:1194808220
Name:WEITMAN, JOSHUA S (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:S
Last Name:WEITMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAIN STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-427-1199
Mailing Address - Fax:631-944-6046
Practice Address - Street 1:124 MAIN STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-427-1199
Practice Address - Fax:631-944-6046
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0387161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice