Provider Demographics
NPI:1346660859
Name:WEINERT, BRIAN LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LAWRENCE
Last Name:WEINERT
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 1:1460 E RED BUG RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6527
Mailing Address - Country:US
Mailing Address - Phone:407-971-1116
Mailing Address - Fax:407-971-7633
Practice Address - Street 1:1460 E RED BUG RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6527
Practice Address - Country:US
Practice Address - Phone:407-971-1116
Practice Address - Fax:407-971-7633
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist