| NPI | 1669200390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK WEIGAND Owner 877-712-7875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2024-07-24 |
| Last Update Date | 2025-05-13 |