Provider Demographics
NPI:1417013640
Name:WEATHERS, TREVOR ROY (DDS)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:ROY
Last Name:WEATHERS
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 1:4141 NW 5TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2158
Mailing Address - Country:US
Mailing Address - Phone:954-791-1220
Mailing Address - Fax:954-791-0631
Practice Address - Street 1:4141 NW 5TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2158
Practice Address - Country:US
Practice Address - Phone:954-791-1220
Practice Address - Fax:954-791-0631
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 113941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery