MEDICARE: STEVEN CLARKE WEINTRAUB 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	D5231	OR

General Provider Information

NPI Number	:	1508862053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN CLARKE WEINTRAUB D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 703
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-0233
Country	:	US
Telephone Number	:	541-928-8434
Fax Number	:	541-928-2756

Provider Business Practice Location Address
First Line	:	721 WAVERLY DR SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-5080
Country	:	US
Telephone Number	:	541-928-8434
Fax Number	:	541-928-2756

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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