Healthcare Provider Details

I. General information

NPI: 1275603649
Provider Name (Legal Business Name): MAURICE H WEINTRAUB DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD STE 12A
NORTH CHARLESTON SC
29406
US

IV. Provider business mailing address

2070 NORTHBROOK BLVD STE 12A
NORTH CHARLESTON SC
29406
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-7827
  • Fax: 843-797-2559
Mailing address:
  • Phone: 843-553-7827
  • Fax: 843-797-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2084
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: