Individual
JORDAN WEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2102 W RANDOLPH ST, VANDALIA, IL 62471-1973
(618) 283-4900
(618) 283-4963
Mailing address
2102 W RANDOLPH ST, VANDALIA, IL 62471-1973
(618) 283-4900
(618) 283-4963
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019030323
IL
Other
Enumeration date
07/23/2015
Last updated
07/23/2015
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