MEDICARE: DR. ALLAN DEAN WEIMER D.D.S., M.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	00300	CO

General Provider Information

NPI Number	:	1699920660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN DEAN WEIMER D.D.S., M.S.

Provider Business Mailing Address
First Line	:	100 PARK AVE.
Second Line	:	SUITE 104
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-5012
Country	:	US
Telephone Number	:	970-879-4290
Fax Number	:	970-879-6481

Provider Business Practice Location Address
First Line	:	100 PARK AVE
Second Line	:	SUITE 104
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-5012
Country	:	US
Telephone Number	:	970-879-4290
Fax Number	:	970-879-6481

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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