Healthcare Provider Details

I. General information

NPI: 1669454757
Provider Name (Legal Business Name): SCOTT LOUIS WEINSTEIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12105 COPPER WAY SUITE 102
CHARLOTTE NC
28277-1756
US

IV. Provider business mailing address

12105 COPPER WAY SUITE 102
CHARLOTTE NC
28277-1756
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-1900
  • Fax: 704-831-6444
Mailing address:
  • Phone: 704-752-1900
  • Fax: 704-831-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7083
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: