MEDICARE: DR. BRETT ERIK WEATHERINGTON 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	1223P0300X	Periodontics	102234	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102234	OTHER	CA	CA STATE LICENSCE

General Provider Information

NPI Number	:	1720697733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT ERIK WEATHERINGTON DDS

Provider Business Mailing Address
First Line	:	17975 SAPONI CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-1388
Country	:	US
Telephone Number	:	858-722-3673
Fax Number	:

Provider Business Practice Location Address
First Line	:	7224 MITSCHER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-0001
Country	:	US
Telephone Number	:	858-722-3673
Fax Number	:

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

Provider Enumeration Date	:	07/26/2020
Last Update Date	:	01/30/2026

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