Provider Demographics
NPI:1164521647
Name:WEISER, REINHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:REINHARD
Middle Name:
Last Name:WEISER
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 1:485 BROADWAY
Mailing Address - Street 2:SUITE #400
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1923
Mailing Address - Country:US
Mailing Address - Phone:650-697-2252
Mailing Address - Fax:650-697-2253
Practice Address - Street 1:485 BROADWAY
Practice Address - Street 2:SUITE #400
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1923
Practice Address - Country:US
Practice Address - Phone:650-697-2252
Practice Address - Fax:650-697-2253
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0322001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice