Provider Demographics
NPI:1871575449
Name:WEILER, THOMAS FREDERICK (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FREDERICK
Last Name:WEILER
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 1:1305 E SUSAN LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6205
Mailing Address - Country:US
Mailing Address - Phone:509-768-7635
Mailing Address - Fax:509-326-4686
Practice Address - Street 1:1912 N DIVISION ST
Practice Address - Street 2:STE. 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2230
Practice Address - Country:US
Practice Address - Phone:509-326-5620
Practice Address - Fax:509-326-4686
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5012455Medicaid
WA5001334Medicare ID - Type UnspecifiedPRACTICE IDENTIFIER