| Organization Name: | BEULAH DENTAL WEISS PC |
| NPI Number: | 1255706933 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESSICA WEISS (PRESIDENT) |
| Mailing Address: | 200 W Main St Beulah |
| State: | ND US |
| Postal Code: | 585236970 |
| Phone Number: | 7018732259 |
| Fax Number: | |
| NPI Enumeration Date: | 12/07/2015 |
| NPI Last Update Date: | 12/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2252 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |