Healthcare Provider Details

I. General information

NPI: 1942590534
Provider Name (Legal Business Name): MARK WEISER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 STATE ST
SANTA BARBARA CA
93101-2513
US

IV. Provider business mailing address

1511 STATE ST
SANTA BARBARA CA
93101-2513
US

V. Phone/Fax

Practice location:
  • Phone: 805-899-3600
  • Fax: 805-899-3605
Mailing address:
  • Phone: 805-899-3600
  • Fax: 805-899-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number28406
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK T. WEISER
Title or Position: OWNER
Credential: DDS
Phone: 805-899-3600