Provider Demographics
NPI:1316960313
Name:WEATHERALL, FELICIA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:MARIE
Last Name:WEATHERALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14315 CYPRESS ROSEHILL RD STE. 150
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4776
Mailing Address - Country:US
Mailing Address - Phone:281-373-4533
Mailing Address - Fax:281-256-1144
Practice Address - Street 1:14315 CYPRESS ROSEHILL
Practice Address - Street 2:SUITE 150
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4776
Practice Address - Country:US
Practice Address - Phone:281-373-4533
Practice Address - Fax:281-256-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX180345401Medicaid