Provider Demographics
NPI:1710917661
Name:WEINER, RANDY SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SCOTT
Last Name:WEINER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1409
Mailing Address - Country:US
Mailing Address - Phone:508-376-4949
Mailing Address - Fax:508-376-1919
Practice Address - Street 1:10 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1409
Practice Address - Country:US
Practice Address - Phone:508-376-4949
Practice Address - Fax:508-376-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice