Provider Demographics
NPI:1700800539
Name:WEINBERG, MELVIN STUART (DDS)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:STUART
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 NE 203RD ST
Mailing Address - Street 2:220
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1900
Mailing Address - Country:US
Mailing Address - Phone:305-931-1987
Mailing Address - Fax:305-936-9403
Practice Address - Street 1:2627 NE 203RD ST
Practice Address - Street 2:220
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1900
Practice Address - Country:US
Practice Address - Phone:305-931-1987
Practice Address - Fax:305-936-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7039122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice