MEDICARE: DR. LEONARD A WEISS DMD

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	DN11176	FL

General Provider Information

NPI Number	:	1457419137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD A WEISS DMD

Provider Business Mailing Address
First Line	:	10019 CLEARY BLVD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-1000
Country	:	US
Telephone Number	:	954-473-6400
Fax Number	:	954-473-0594

Provider Business Practice Location Address
First Line	:	10019 CLEARY BLVD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-1000
Country	:	US
Telephone Number	:	954-473-6400
Fax Number	:	954-473-0594

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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