Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 9048 | KY |
Y | 1223E0200X | Endodontist | 9048 | KY |
NPI | 1033499496 |
---|---|
Provider Name | Dr. Jacob Nicholas Weigle |
First Address | Lexington, KY 40517-4125 |
Second Address | Lexington, KY 40517-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2011 |
Last Update Date | 06/08/2020 |