Healthcare Provider Details

I. General information

NPI: 1457791501
Provider Name (Legal Business Name): DENNIS E. WEILAND, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11779 N 114TH WAY
SCOTTSDALE AZ
85259-2607
US

IV. Provider business mailing address

11779 N 114TH WAY
SCOTTSDALE AZ
85259-2607
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-6652
  • Fax: 480-767-6652
Mailing address:
  • Phone: 480-767-6652
  • Fax: 480-767-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4749
License Number StateAZ

VIII. Authorized Official

Name: DR. DENNIS EDWARD WEILAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 489-767-6652