MEDICARE: DR. ANDREW T WEIR 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	4918	AZ

General Provider Information

NPI Number	:	1356431118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW T WEIR D.D.S.

Provider Business Mailing Address
First Line	:	1423 S HIGLEY RD
Second Line	:	SUITE 117
City	:	MESA
State	:	AZ
Zip	:	85206-3429
Country	:	US
Telephone Number	:	480-807-3332
Fax Number	:	480-807-1200

Provider Business Practice Location Address
First Line	:	1423 S HIGLEY RD
Second Line	:	SUITE 117
City	:	MESA
State	:	AZ
Zip	:	85206-3429
Country	:	US
Telephone Number	:	480-807-3332
Fax Number	:	480-807-1200

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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