Provider Demographics
NPI:1053328369
Name:WEINER, RONALD (DMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:WEINER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 US HIGHWAY 46
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2142
Mailing Address - Country:US
Mailing Address - Phone:973-334-2255
Mailing Address - Fax:973-334-7122
Practice Address - Street 1:1180 US HIGHWAY 46
Practice Address - Street 2:SUITE 211
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2142
Practice Address - Country:US
Practice Address - Phone:973-334-2255
Practice Address - Fax:973-334-7122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009052001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI00905200OtherNJ REGISTRATION NUMBER