Provider Demographics
NPI:1588157101
Name:WEIMERSKIRCH FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:WEIMERSKIRCH FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIMERSKIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-747-2263
Mailing Address - Street 1:406 WALL ST
Mailing Address - Street 2:
Mailing Address - City:EAST DUBUQUE
Mailing Address - State:IL
Mailing Address - Zip Code:61025-1432
Mailing Address - Country:US
Mailing Address - Phone:815-747-2263
Mailing Address - Fax:815-747-2265
Practice Address - Street 1:406 WALL ST
Practice Address - Street 2:
Practice Address - City:EAST DUBUQUE
Practice Address - State:IL
Practice Address - Zip Code:61025
Practice Address - Country:US
Practice Address - Phone:815-747-2263
Practice Address - Fax:815-747-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty