MEDICARE: DR. JEFFREY LAWRENCE WEISBROT DDS

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	1223G0001X	General Practice Dentistry	60467	KS
2	1223G0001X	General Practice Dentistry	6756	AZ
3	1223G0001X	General Practice Dentistry	22011	OH

General Provider Information

NPI Number	:	1427080829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LAWRENCE WEISBROT DDS

Provider Business Mailing Address
First Line	:	910 LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-2795
Country	:	US
Telephone Number	:	513-683-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-2795
Country	:	US
Telephone Number	:	513-683-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/22/2020

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