Adrianza-Weidanz, Marielsa Adrianza

Adrianza-Weidanz, Marielsa Adrianza is an individual health care provider with primary practice located at 4100 S Ferdon Blvd Suite C2, Crestview FL 32536-5252. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / General Practice is her primary health care specialty. Adrianza-Weidanz, Marielsa Adrianza can be contacted via phone (850) 423-4603.

Contact Information

Primary practice address
4100 S Ferdon Blvd Suite C2 Crestview FL 32536-5252
Phone: (850) 423-4603
Fax: (850) 423-0473
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 20288 Texas
Dental Providers / Dentist 122300000X 13927 Texas
Dental Providers / General Practice 1223G0001X DN14799 Florida

Profile Details

NPI number 1750495149
LBN Legal business name Adrianza-Weidanz, Marielsa Adrianza
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 19th, 2006
Last updated Aug 15th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750495149 NPPES
Florida MEDICAID 008109700

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