Provider Demographics
NPI:1669865101
Name:MARK L WEISS DMD PA
Entity Type:Organization
Organization Name:MARK L WEISS DMD PA
Other - Org Name:MARK L WEISS DMD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-940-3135
Mailing Address - Street 1:1660 NE MIAMI GARDENS DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4924
Mailing Address - Country:US
Mailing Address - Phone:305-940-3135
Mailing Address - Fax:305-944-6602
Practice Address - Street 1:1660 NE MIAMI GARDENS DR
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4924
Practice Address - Country:US
Practice Address - Phone:305-940-3135
Practice Address - Fax:305-944-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty