MEDICARE: THOMAS MAURICE WEIL 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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	7991	TX

General Provider Information

NPI Number	:	1356346613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MAURICE WEIL DDS

Provider Business Mailing Address
First Line	:	5066 FIELDWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-2410
Country	:	US
Telephone Number	:	713-961-1440
Fax Number	:	713-961-0929

Provider Business Practice Location Address
First Line	:	2450 FONDREN RD
Second Line	:	STE 320
City	:	HOUSTON
State	:	TX
Zip	:	77063-2320
Country	:	US
Telephone Number	:	713-783-5560
Fax Number	:	713-783-7333

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/24/2007

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