Provider Demographics
NPI:1740473941
Name:WEISS, MARK L (DMD, PA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:WEISS
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN109921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice