Provider Demographics
NPI:1063008894
Name:WDW BIRMINGHAM PLLC
Entity Type:Organization
Organization Name:WDW BIRMINGHAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-880-6190
Mailing Address - Street 1:1000 S OLD WOODWARD AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6729
Mailing Address - Country:US
Mailing Address - Phone:248-645-1060
Mailing Address - Fax:248-833-0126
Practice Address - Street 1:1000 S OLD WOODWARD AVE STE 106
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6729
Practice Address - Country:US
Practice Address - Phone:248-645-1060
Practice Address - Fax:248-833-0126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WDW ROSEVILLE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty