Provider Demographics
NPI:1003990581
Name:WEISFOGEL, AVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:AVI
Middle Name:
Last Name:WEISFOGEL
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 1:30 STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1420
Mailing Address - Country:US
Mailing Address - Phone:732-257-5600
Mailing Address - Fax:732-651-1454
Practice Address - Street 1:30 STATE ROUTE 18
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1420
Practice Address - Country:US
Practice Address - Phone:732-257-5600
Practice Address - Fax:732-651-1454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI207831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice