Provider Demographics
NPI:1235970609
Name:WEISS, LUCAS PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:PAUL
Last Name:WEISS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 COLONY DR N STE 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7188
Mailing Address - Country:US
Mailing Address - Phone:989-971-2228
Mailing Address - Fax:
Practice Address - Street 1:5545 COLONY DR N STE 3
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7188
Practice Address - Country:US
Practice Address - Phone:989-799-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016022431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice