Provider Demographics
NPI:1497768386
Name:WEINSTEIN, MICHAEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
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 1:3450 ELLICOTT CENTER DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4172
Mailing Address - Country:US
Mailing Address - Phone:410-465-6800
Mailing Address - Fax:410-461-4727
Practice Address - Street 1:3450 ELLICOTT CENTER DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4172
Practice Address - Country:US
Practice Address - Phone:410-465-6800
Practice Address - Fax:410-461-4727
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD56161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
R877Medicare ID - Type Unspecified