MEDICARE: MELVYN WEINSTOCK DDS PHD PLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN0009925	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447520804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELVYN WEINSTOCK DDS PHD PLC

Provider Business Mailing Address
First Line	:	8588 STARKEY RD STE C
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33777-2831
Country	:	US
Telephone Number	:	727-392-7734
Fax Number	:	727-319-3828

Provider Business Practice Location Address
First Line	:	8588 STARKEY RD STE C
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33777-2831
Country	:	US
Telephone Number	:	727-392-7734
Fax Number	:	727-319-3828

Authorized Official
Title or Position	:	OWNER
Name	:	MELVYN WEINSTOCK
Credential	:	DDS PHD PLC
Telephone Number	:	727-392-7734

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/03/2012

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