Provider Demographics
NPI:1306152889
Name:WEYHER, MCKINSEE BRODERICK (DDS)
Entity type:Individual
Prefix:
First Name:MCKINSEE
Middle Name:BRODERICK
Last Name:WEYHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MCKINSEE
Other - Middle Name:CATHRYN
Other - Last Name:BRODERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2114 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2807
Mailing Address - Country:US
Mailing Address - Phone:385-399-0537
Mailing Address - Fax:801-880-8835
Practice Address - Street 1:2114 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2807
Practice Address - Country:US
Practice Address - Phone:385-399-0537
Practice Address - Fax:801-880-8835
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59546122300000X
AK1361122300000X
UT8088273-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1361OtherDENTAL LICENSE
CA59546OtherDENTAL LICENSE
UT8088273-9922OtherUTAH DENTAL LICENSE