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General NPI Number Information
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NPI Number | 1407184104
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Entity Type | Organization
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Legal Business Name | STEPHEN A WEINER DDS PA
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 124 SLADE AVE 101
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City | BALTIMORE
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State | MD
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Zip | 21208-4900
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Country | US
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Telephone | 410-764-0330
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Fax | 410-764-0356
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Provider Business Mailing Address
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Address Line | 124 SLADE AVE 101
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City | BALTIMORE
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State | MD
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Zip | 21208-4900
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Country | US
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Telephone | 410-764-0330
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Fax | 410-764-0356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN ALAN WEINER
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Credential | DDS
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Telephone | 410-764-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08698
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4658
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License Number State | MD
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