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General NPI Number Information
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NPI Number | 1528272135
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Entity Type | Organization
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Legal Business Name | DELTA HEALTH MANAGEMENT, INC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 DOCTORS LN
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City | LAKE WALES
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State | FL
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Zip | 33853-4956
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Country | US
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Telephone | 863-676-8536
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Fax | 863-676-1629
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Provider Business Mailing Address
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Address Line | 1 DOCTORS LN
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City | LAKE WALES
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State | FL
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Zip | 33853-4956
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Country | US
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Telephone | 863-676-8536
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Fax | 863-676-1629
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MAURICE MAXWELL WEAVER
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Credential | DDS
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Telephone | 863-676-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5771
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License Number State | FL
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