Provider Demographics
NPI:1487614186
Name:WEISSMAN, GERALD M (DDS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:M
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 1:44 W MAIN ST
Mailing Address - Street 2:P O BOX 73
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1227
Mailing Address - Country:US
Mailing Address - Phone:614-879-7319
Mailing Address - Fax:614-879-9744
Practice Address - Street 1:44 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1227
Practice Address - Country:US
Practice Address - Phone:614-879-7319
Practice Address - Fax:614-879-9744
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300130011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078526OtherOHIO DEPT OF JOBS & FAMIL