Provider Demographics
NPI:1447446737
Name:RENEE L WEICHEL DMD PC
Entity type:Organization
Organization Name:RENEE L WEICHEL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:503-691-8900
Mailing Address - Street 1:18761 SW MARTINA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062
Mailing Address - Country:US
Mailing Address - Phone:503-691-8900
Mailing Address - Fax:503-691-8992
Practice Address - Street 1:18761 SW MARTINA AVENUE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062
Practice Address - Country:US
Practice Address - Phone:503-691-8900
Practice Address - Fax:503-691-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty