MEDICARE: CURTIS DEAN WEYRAUCH DDS

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	D9015	MN

General Provider Information

NPI Number	:	1639238892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS DEAN WEYRAUCH DDS

Provider Business Mailing Address
First Line	:	1099 MOORE LAKE E DR
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-5153
Country	:	US
Telephone Number	:	763-586-9988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1099 EAST MOORE LAKE DRIVE
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432
Country	:	US
Telephone Number	:	763-586-9988
Fax Number	:	763-586-9977

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	12/23/2015

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