Provider Demographics
NPI:1194899088
Name:WEISS, MARVIN G (DDS)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:G
Last Name:WEISS
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 1:1024 PARK AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3026
Mailing Address - Country:US
Mailing Address - Phone:908-757-6200
Mailing Address - Fax:908-757-0366
Practice Address - Street 1:1024 PARK AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3026
Practice Address - Country:US
Practice Address - Phone:908-757-6200
Practice Address - Fax:908-757-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ97971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics