Provider Demographics
NPI:1285796201
Name:WEIS, TIMOTHY PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:WEIS
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 1:2566 ELLIS AVE
Mailing Address - Street 2:UNIT 109
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1445
Mailing Address - Country:US
Mailing Address - Phone:612-703-6991
Mailing Address - Fax:
Practice Address - Street 1:4000 CENTRAL AVE NE STE 308
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2971
Practice Address - Country:US
Practice Address - Phone:763-781-7475
Practice Address - Fax:763-781-0828
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice