Provider Demographics
NPI:1073666962
Name:WEINSTEIN, GREGG RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:RUSSELL
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE SPANISH RIVER BLVD
Mailing Address - Street 2:SUITE-34
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4515
Mailing Address - Country:US
Mailing Address - Phone:561-392-1606
Mailing Address - Fax:561-392-0704
Practice Address - Street 1:500 NE SPANISH RIVER BLVD
Practice Address - Street 2:SUITE-34
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4515
Practice Address - Country:US
Practice Address - Phone:561-392-1606
Practice Address - Fax:561-392-0704
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 155151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice