Marielsa Adrianza Adrianza-Weidanz, DDS
Individual provider Active NPI General Practice Dentistry · Crestview, FL
NPI 1750495149 · NPPES record last updated Aug 15, 2013
Key facts
- NPI
- 1750495149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN14799 (FL)
- Practice address
- 4100 S Ferdon Blvd
Suite C2
Crestview, FL 32536-5252 - Phone
- (850) 423-4603
- Fax
- (850) 423-0473
- NPI assigned
- Aug 19, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN14799 | FL | MD | General Practice Dentistry |
| 20288 | TX | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 20288 | TX | |
| Dentist | 122300000X | 13927 | TX | |
| General Practice Dentistry | 1223G0001X | DN14799 | FL | Yes |
Addresses
Primary practice location
4100 S Ferdon Blvd
Suite C2
Crestview, FL 32536-5252
Mailing address
2804 Remington Green Cir Ste 2
Tallahassee, FL 32308-1550
Phone (850) 385-4494
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008109700 | Medicaid | FL |
Other providers in Crestview, FL
- Lauren Adams
- Lindsay K Adams
- Pamela Elizabeth Adams
- Jennifer Adkins
- Rosemonde Adolphe
- Advanced Family Medicine Clinic Inc
- Advantage Dental Oral Health Center of Florida PA
- Desiree Ahlborn
- Amir Ahmadian
- Anthony Al-Dehneh
All providers in Crestview, FL · General Practice Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.