Provider Demographics
NPI:1902468226
Name:WEISS, KELSEY M (DMD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:M
Last Name:WEISS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5028
Mailing Address - Country:US
Mailing Address - Phone:919-562-7008
Mailing Address - Fax:
Practice Address - Street 1:1900 S MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5028
Practice Address - Country:US
Practice Address - Phone:919-562-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice