Provider Demographics
NPI:1114056611
Name:WEINER, MITCHELL LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:LOUIS
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 1:3084 STATE ROUTE 27
Mailing Address - Street 2:SUITE #2
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1657
Mailing Address - Country:US
Mailing Address - Phone:732-297-4900
Mailing Address - Fax:732-297-4860
Practice Address - Street 1:3084 STATE ROUTE 27
Practice Address - Street 2:SUITE #2
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1657
Practice Address - Country:US
Practice Address - Phone:732-297-4900
Practice Address - Fax:732-297-4860
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 174061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice