MEDICARE: DR. R. GEOFFREY WEIHE 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	122300000X	Dentist	DN4730	FL

General Provider Information

NPI Number	:	1477728681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. R. GEOFFREY WEIHE D.D.S.

Provider Business Mailing Address
First Line	:	612 W DE LEON ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2720
Country	:	US
Telephone Number	:	813-253-3041
Fax Number	:	813-254-3389

Provider Business Practice Location Address
First Line	:	612 W DE LEON ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2720
Country	:	US
Telephone Number	:	813-253-3041
Fax Number	:	813-254-3389

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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