Provider Demographics
NPI:1194068791
Name:WEINSTOCK, MICHAEL L (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:WEINSTOCK
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 1:664 PALM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7847
Mailing Address - Country:US
Mailing Address - Phone:407-834-6446
Mailing Address - Fax:407-830-4978
Practice Address - Street 1:664 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7847
Practice Address - Country:US
Practice Address - Phone:407-834-6446
Practice Address - Fax:407-830-4978
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 50151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice