Provider Demographics
NPI:1083787402
Name:WEISBERG, DAVID CASEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CASEY
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 1:4224 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1577
Mailing Address - Country:US
Mailing Address - Phone:586-756-6351
Mailing Address - Fax:586-756-6253
Practice Address - Street 1:4224 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1577
Practice Address - Country:US
Practice Address - Phone:586-756-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice