Provider Demographics
NPI:1396808952
Name:BRIAN L WEINERT DDS PA
Entity type:Organization
Organization Name:BRIAN L WEINERT DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-971-1116
Mailing Address - Street 1:1460 E RED BUG RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6527
Mailing Address - Country:US
Mailing Address - Phone:407-971-1116
Mailing Address - Fax:407-971-7633
Practice Address - Street 1:1460 E RED BUG RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6527
Practice Address - Country:US
Practice Address - Phone:407-971-1116
Practice Address - Fax:407-971-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00135111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty