MEDICARE: SCOTT L WEINSTEIN DDS 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	1223P0221X	Pediatric Dentistry	7083	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730373655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT L WEINSTEIN DDS PA

Provider Business Mailing Address
First Line	:	12105 COPPER WAY
Second Line	:	SUITE 102
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-1756
Country	:	US
Telephone Number	:	704-752-1900
Fax Number	:	704-831-6444

Provider Business Practice Location Address
First Line	:	12105 COPPER WAY
Second Line	:	SUITE 102
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-1756
Country	:	US
Telephone Number	:	704-752-1900
Fax Number	:	704-831-6444

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT LOUIS WEINSTEIN
Credential	:	DDS
Telephone Number	:	704-752-1900

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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