Individual provider Active NPI

Bailey Kate Weightman, DDS

  • Endodontics
  • Mount Pleasant, SC
National Provider Identifier
1053813907
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
061760-01 Issued in NY
Practice address
115 Elizabeth St
Mount Pleasant, SC 29464-5330
Phone
(518) 593-5428
NPI assigned
Mar 7, 2018
Last updated
Sep 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 10276 SC
Endodontics 1223E0200X 061760-01 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X NY

Addresses

Primary practice location

115 Elizabeth St
Mount Pleasant, SC 29464-5330

Mailing address

5715 State Route 374
Chateaugay, NY 12920-4705
Phone (518) 593-5428

Other practice location 1

Stony Brook School of Dental Medicine
151 Westchester Hall
Stony, NY 12974
Phone (631) 444-2557

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
061760-01NYMDEndodontist
10276SCMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Bailey Weightman, DDS, MSD, LLC Endodontics CurrentSince Sep 28, 2025 Accepting new patients
Lake Front Dental Group PC Endodontics PastSince Nov 1, 2024 Accepting new patients
Innovative Endodontics Endodontics PastSince Oct 2, 2022 Accepting new patients

Locations

115 Elizabeth St
Mount Pleasant, SC 29464
Phone (518) 593-5428

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1053813907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5715 STATE ROUTE 374",
            "city": "CHATEAUGAY",
            "state": "NY",
            "postal_code": "129204705",
            "telephone_number": "518-593-5428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ELIZABETH ST",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294645330",
            "telephone_number": "518-593-5428"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Stony Brook School of Dental Medicine",
            "address_2": "151 Westchester Hall",
            "address_purpose": "LOCATION",
            "city": "Stony",
            "state": "NY",
            "postal_code": "12974",
            "country_code": "US",
            "telephone_number": "631-444-2557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEIGHTMAN",
        "first_name": "BAILEY",
        "middle_name": "KATE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-07",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "SC",
            "license": "10276",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "061760-01",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.