Provider Demographics
NPI:1891878088
Name:WEISS, RICHARD R
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:WEISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 213TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1554
Mailing Address - Country:US
Mailing Address - Phone:718-229-6600
Mailing Address - Fax:718-224-4955
Practice Address - Street 1:3443 213TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1554
Practice Address - Country:US
Practice Address - Phone:718-229-6600
Practice Address - Fax:718-224-4955
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0281891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics