Individual
MR. DUSTIN FREDERICK WEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
505 S MOUNTAIN VIEW RD STE 4, MOSCOW, ID 83843-9205
(208) 882-2986
(208) 882-2987
Mailing address
505 S MOUNTAIN VIEW RD STE 4, MOSCOW, ID 83843-9205
(208) 882-2986
(208) 882-2987
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D13926
MN
1223E0200X
Endodontics
Primary
D-3556-EN
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806107300
—
ID
Enumeration date
03/27/2007
Last updated
10/03/2020
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