Provider Demographics
NPI:1003037292
Name:WEINER, JEFFREY MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARC
Last Name:WEINER
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 1:3254 RED LION RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1109
Mailing Address - Country:US
Mailing Address - Phone:215-632-1612
Mailing Address - Fax:215-632-3221
Practice Address - Street 1:3254 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1109
Practice Address - Country:US
Practice Address - Phone:215-632-1612
Practice Address - Fax:215-632-3221
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019951-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice