Provider Demographics
NPI:1023236031
Name:WEIMAR, WILLIAM C (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:WEIMAR
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 1:7963 E HAMPDEN CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1405
Mailing Address - Country:US
Mailing Address - Phone:303-694-3510
Mailing Address - Fax:
Practice Address - Street 1:100 ACOMA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1464
Practice Address - Country:US
Practice Address - Phone:303-778-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02049252Medicaid