Provider Demographics
NPI:1447520804
Name:MELVYN WEINSTOCK DDS PHD PLC
Entity type:Organization
Organization Name:MELVYN WEINSTOCK DDS PHD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHD PLC
Authorized Official - Phone:727-392-7734
Mailing Address - Street 1:8588 STARKEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-2831
Mailing Address - Country:US
Mailing Address - Phone:727-392-7734
Mailing Address - Fax:727-319-3828
Practice Address - Street 1:8588 STARKEY RD STE C
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-2831
Practice Address - Country:US
Practice Address - Phone:727-392-7734
Practice Address - Fax:727-319-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00099251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194734293Medicaid