Provider Demographics
NPI:1447350343
Name:WEATHERS, BRET A (DDS)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:A
Last Name:WEATHERS
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 1:4130 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-2613
Mailing Address - Country:US
Mailing Address - Phone:317-359-7244
Mailing Address - Fax:317-359-0248
Practice Address - Street 1:4130 E 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-2613
Practice Address - Country:US
Practice Address - Phone:317-359-7244
Practice Address - Fax:317-359-0248
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice