1356454763 NPI number — DR. TAMMY RENEE WEYANDT DDS

Table of content: DR. TAMMY RENEE WEYANDT DDS (NPI 1356454763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356454763 NPI number — DR. TAMMY RENEE WEYANDT DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEYANDT
Provider First Name:
TAMMY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356454763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5805 ANDOVER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-442-5207
Provider Business Mailing Address Fax Number:
972-359-6311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 S ALLEN HEIGHTS
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-359-6611
Provider Business Practice Location Address Fax Number:
972-359-6311
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  19591 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 731266 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119716 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




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