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General NPI Number Information
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NPI Number | 1720367188
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Entity Type | Individual
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Provider Name | BRANDT LEE WEININGER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 12/19/2015
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Provider Practice Location Address
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Address Line | 2540 S STATE ROUTE 100
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City | TIFFIN
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State | OH
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Zip | 44883-9356
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Country | US
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Telephone | 419-937-6168
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Fax |
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Provider Business Mailing Address
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Address Line | 647 HEDGEGATE SOUTH CT
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City | TIFFIN
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State | OH
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Zip | 44883-3186
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Country | US
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Telephone | 419-937-6168
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7052
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License Number State | SC
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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 | 30.023501
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License Number State | OH
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