MEDICARE: DR. MARC WEIAND D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7926	WA

General Provider Information

NPI Number	:	1043243108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC WEIAND D.D.S.

Provider Business Mailing Address
First Line	:	1414 N VERCLER RD
Second Line	:	STE 6
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1092
Country	:	US
Telephone Number	:	509-926-1589
Fax Number	:	509-464-6231

Provider Business Practice Location Address
First Line	:	1414 N VERCLER RD
Second Line	:	#6
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1092
Country	:	US
Telephone Number	:	509-926-1589
Fax Number	:	509-892-5168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/20/2016

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