MEDICARE: MARK L WEISS DMD PA

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

General Provider Information

NPI Number	:	1669865101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK L WEISS DMD PA

Provider Business Mailing Address
First Line	:	1660 NE MIAMI GARDENS DR
Second Line	:	SUITE 3
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-4924
Country	:	US
Telephone Number	:	305-940-3135
Fax Number	:	305-944-6602

Provider Business Practice Location Address
First Line	:	1660 NE MIAMI GARDENS DR
Second Line	:	SUITE 3
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-4924
Country	:	US
Telephone Number	:	305-940-3135
Fax Number	:	305-944-6602

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK L WEISS
Credential	:	DMD
Telephone Number	:	305-940-3135

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	03/09/2015

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