Provider Demographics
NPI:1952497190
Name:WEIDER, GARY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:WEIDER
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 1:21355 E DIXIE HWY
Mailing Address - Street 2:STE 105
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-935-2122
Mailing Address - Fax:
Practice Address - Street 1:21355 EAST DIXIE HIGHWAY
Practice Address - Street 2:STE 105
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-935-2122
Practice Address - Fax:305-466-4226
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00118971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice