Active NPI
Dustin Frederick Weitz, D.D.S., M.S.
- Endodontics
- Moscow, ID
National Provider Identifier
1952429946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D-3556-EN
- Practice address
- 505 S Mountain View Rd Ste 4
Moscow, ID 83843-9205 - Phone
- (208) 882-2986
- Fax
- (208) 882-2987
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D13926 | MN | |
| Endodontics | 1223E0200X | D-3556-EN | ID | Primary |
Addresses
Primary practice location
505 S Mountain View Rd Ste 4
Moscow, ID 83843-9205
Mailing address
505 S Mountain View Rd Ste 4
Moscow, ID 83843-9205
Phone (208) 882-2986
Other practice location 1
Division of Endodontics, University of Minnesota
515 Delaware Ave SE 8-166 Moos Health Sciences Tower
Minneapolis, MN 55455
Phone (612) 624-9900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806107300 | Medicaid | ID |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13926 | MN | MD | Dentist |
| D-3556-EN | ID | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601683200000",
"number": "1952429946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 S MOUNTAIN VIEW RD STE 4",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838439205",
"telephone_number": "208-882-2986",
"fax_number": "208-882-2987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 S MOUNTAIN VIEW RD STE 4",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838439205",
"telephone_number": "208-882-2986",
"fax_number": "208-882-2987"
}
],
"practiceLocations": [
{
"address_1": "Division of Endodontics, University of Minnesota",
"address_2": "515 Delaware Ave SE 8-166 Moos Health Sciences Tower",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "55455",
"country_code": "US",
"telephone_number": "612-624-9900",
"fax_number": "612-624-7960",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WEITZ",
"first_name": "DUSTIN",
"middle_name": "FREDERICK",
"name_prefix": "Mr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2020-10-03",
"certification_date": "2020-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D13926",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "ID",
"license": "D-3556-EN",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806107300",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.