Provider Demographics
NPI:1639057789
Name:LICENSE TO DRILL LLC
Entity type:Organization
Organization Name:LICENSE TO DRILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICKOLAUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-279-9767
Mailing Address - Street 1:212 E WINSLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8657
Mailing Address - Country:US
Mailing Address - Phone:812-337-8888
Mailing Address - Fax:
Practice Address - Street 1:212 E WINSLOW RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8657
Practice Address - Country:US
Practice Address - Phone:812-337-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental