Provider Demographics
NPI:1518225432
Name:BROOKSIDE DENTAL, INC.
Entity Type:Organization
Organization Name:BROOKSIDE DENTAL, INC.
Other - Org Name:MARK WEISSMAN, D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-345-3439
Mailing Address - Street 1:10689 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2014
Mailing Address - Country:US
Mailing Address - Phone:954-345-3439
Mailing Address - Fax:954-345-8862
Practice Address - Street 1:10689 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2014
Practice Address - Country:US
Practice Address - Phone:954-345-3439
Practice Address - Fax:954-345-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN07629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty