Provider Demographics
NPI:1245358290
Name:WESTON, MARIA LYNN (RDH)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LYNN
Last Name:WESTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5138 CR 6
Mailing Address - Street 2:
Mailing Address - City:OADENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-393-1315
Mailing Address - Fax:
Practice Address - Street 1:4 COMMERCE LN
Practice Address - Street 2:UNITED CEREBRAL PALSEY OF THE NORTH COUNTRY
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-8191
Practice Address - Fax:315-386-1410
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995615Medicaid