Provider Demographics
NPI:1053504530
Name:WEISBERG, EDWARD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:WEISBERG
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 1:801 W LITTLE CREEK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2036
Mailing Address - Country:US
Mailing Address - Phone:757-440-0044
Mailing Address - Fax:757-440-0092
Practice Address - Street 1:801 W LITTLE CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2036
Practice Address - Country:US
Practice Address - Phone:757-440-0044
Practice Address - Fax:757-440-0092
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA45151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007805411Medicaid