Provider Demographics
NPI:1326125410
Name:DUTRO SYSTEMS INC
Entity Type:Organization
Organization Name:DUTRO SYSTEMS INC
Other - Org Name:WEISEL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-939-2099
Mailing Address - Street 1:1730 S PINELLAS AVE
Mailing Address - Street 2:SUITES J&K
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1959
Mailing Address - Country:US
Mailing Address - Phone:727-939-2099
Mailing Address - Fax:727-937-2298
Practice Address - Street 1:1730 S PINELLAS AVE
Practice Address - Street 2:SUITES J&K
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1959
Practice Address - Country:US
Practice Address - Phone:727-939-2099
Practice Address - Fax:727-937-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0010195261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9677OtherSAFEGUARD
FL60453OtherBLUECROSS BLUESHIELD
FL4011OtherCOMPBENEFITS
FL15141OtherFORTIS
FL700016OtherUNITED CONCORDIA
FL215753OtherCIGNA
FL42082OtherADI