MEDICARE: DR. CARLIN WEAVER

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN1856790	MA

General Provider Information

NPI Number	:	1679902613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLIN WEAVER

Provider Business Mailing Address
First Line	:	36 DARTMOUTH ST
Second Line	:	#3
City	:	BOSTON
State	:	MA
Zip	:	02116-5956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 SALEM ST
Second Line	:
City	:	SWAMPSCOTT
State	:	MA
Zip	:	01907-1306
Country	:	US
Telephone Number	:	781-581-1550
Fax Number	:

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

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	10/05/2015

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Directions to “ DR. CARLIN WEAVER ” Practice Location

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