Provider Demographics
NPI:1144349515
Name:WEIDLER, STEVEN E (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:WEIDLER
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 1:31610 RAILROAD CANYON RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9454
Mailing Address - Country:US
Mailing Address - Phone:951-244-1340
Mailing Address - Fax:951-244-5377
Practice Address - Street 1:31610 RAILROAD CANYON RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9454
Practice Address - Country:US
Practice Address - Phone:951-244-1340
Practice Address - Fax:951-244-5377
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice