Provider Demographics
NPI:1114082468
Name:WEISBERG, LEE RONALD (DDS MS INC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:RONALD
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:DDS MS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:#212
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-461-5524
Mailing Address - Fax:440-461-4991
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:#212
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-461-5524
Practice Address - Fax:440-461-4991
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135679Medicaid