=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730373655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT L WEINSTEIN DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2007
-----------------------------------------------------
Last Update Date | 09/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12105 COPPER WAY SUITE 102
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-752-1900
-----------------------------------------------------
Fax | 704-831-6444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12105 COPPER WAY SUITE 102
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-752-1900
-----------------------------------------------------
Fax | 704-831-6444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT LOUIS WEINSTEIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 704-752-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 7083
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------