Provider Demographics
NPI:1356431118
Name:WEIR, ANDREW T (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:WEIR
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 1:1423 S HIGLEY RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3429
Mailing Address - Country:US
Mailing Address - Phone:480-807-3332
Mailing Address - Fax:480-807-1200
Practice Address - Street 1:1423 S HIGLEY RD
Practice Address - Street 2:SUITE 117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3429
Practice Address - Country:US
Practice Address - Phone:480-807-3332
Practice Address - Fax:480-807-1200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861046967OtherTAX ID NUMBER