MEDICARE: WEAVER ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN1856790	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1679902613	OTHER	MA	NPI TYPE 1

General Provider Information

NPI Number	:	1083124895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEAVER ORTHODONTICS

Provider Business Mailing Address
First Line	:	230 SALEM ST
Second Line	:
City	:	SWAMPSCOTT
State	:	MA
Zip	:	01907-1306
Country	:	US
Telephone Number	:	781-581-1550
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 SALEM ST
Second Line	:
City	:	SWAMPSCOTT
State	:	MA
Zip	:	01907-1306
Country	:	US
Telephone Number	:	781-581-1550
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLIN WEAVER
Credential	:	DMD
Telephone Number	:	781-581-1550

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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Directions to “WEAVER ORTHODONTICS ” Practice Location

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