Provider Demographics
NPI:1699467167
Name:WEISSMAN, ELIJAH LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:LOUIS
Last Name:WEISSMAN
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 1:3637 E 48TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1922
Mailing Address - Country:US
Mailing Address - Phone:580-695-6393
Mailing Address - Fax:
Practice Address - Street 1:2145 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1001
Practice Address - Country:US
Practice Address - Phone:918-948-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist