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NPI Code Detail

MEDICARE: DR. BRET A WEATHERS D.D.S.

MEDICARE: DR. BRET A WEATHERS D.D.S.
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
11223G0001XGeneral Practice Dentistry12009053IN

General Provider Information

NPI Number : 1447350343
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRET A WEATHERS D.D.S.
Provider Business Mailing Address
First Line : 4130 E 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46201-2613
Country : US
Telephone Number : 317-359-7244
Fax Number : 317-359-0248
Provider Business Practice Location Address
First Line : 4130 E 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46201-2613
Country : US
Telephone Number : 317-359-7244
Fax Number : 317-359-0248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 07/08/2007

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Directions to “ DR. BRET A WEATHERS D.D.S.” Practice Location

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