Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 040110496 | VA |
N | 1223P0221X | Pediatric Dentist | 051082 | NY |
NPI | 1033192398 |
---|---|
Provider Name | Morgan Trey Weis |
First Address | Portsmouth, VA 23703-4505 |
Second Address | Portsmouth, VA 23703-4505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 03/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02532658 | (05) | NY |
02532658 | (05) | VA |