MEDICARE: DR. BENJAMIN WEISER D.D.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	122300000X	Dentist	MD5823	MD

General Provider Information

NPI Number	:	1942406541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN WEISER D.D.S.

Provider Business Mailing Address
First Line	:	64 SOUDER RD
Second Line	:
City	:	BRUNSWICK
State	:	MD
Zip	:	21716-1245
Country	:	US
Telephone Number	:	301-834-6700
Fax Number	:	301-834-5225

Provider Business Practice Location Address
First Line	:	64 SOUDER RD
Second Line	:
City	:	BRUNSWICK
State	:	MD
Zip	:	21716-1245
Country	:	US
Telephone Number	:	301-834-6700
Fax Number	:	301-834-5225

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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