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NPI Code Detail

MEDICARE: DR. MARK T WEISER D.D.S.

MEDICARE: DR. MARK T WEISER 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
11223G0001XGeneral Practice Dentistry28406CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128406OTHERCASTATE LICENSE

General Provider Information

NPI Number : 1538285382
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK T WEISER D.D.S.
Provider Business Mailing Address
First Line : 1511 STATE ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-2513
Country : US
Telephone Number : 805-899-3600
Fax Number : 805-899-3605
Provider Business Practice Location Address
First Line : 1511 STATE ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-2513
Country : US
Telephone Number : 805-899-3600
Fax Number : 805-899-3605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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