MEDICARE: DR. BRIAN LAWRENCE WEINERT DDS

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	122300000X	Dentist	DN0013511	FL

General Provider Information

NPI Number	:	1346660859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN LAWRENCE WEINERT DDS

Provider Business Mailing Address
First Line	:	1460 E RED BUG RD
Second Line	:	SUITE 1000
City	:	OVIEDO
State	:	FL
Zip	:	32765-6527
Country	:	US
Telephone Number	:	407-971-1116
Fax Number	:	407-971-7633

Provider Business Practice Location Address
First Line	:	1460 E RED BUG RD
Second Line	:	SUITE 1000
City	:	OVIEDO
State	:	FL
Zip	:	32765-6527
Country	:	US
Telephone Number	:	407-971-1116
Fax Number	:	407-971-7633

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

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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