Provider Demographics
NPI:1144246810
Name:WEISSMAN, RONALD G (DMD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7414
Mailing Address - Country:US
Mailing Address - Phone:781-647-0772
Mailing Address - Fax:781-647-1086
Practice Address - Street 1:875 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7414
Practice Address - Country:US
Practice Address - Phone:781-647-0772
Practice Address - Fax:781-647-1086
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA129251223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics