Provider Demographics
NPI:1295828903
Name:WEINER, FRED LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:LEE
Last Name:WEINER
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 1:18399 VENTURA BLVD
Mailing Address - Street 2:#254
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4233
Mailing Address - Country:US
Mailing Address - Phone:818-881-1231
Mailing Address - Fax:818-881-1981
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:#254
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-881-1231
Practice Address - Fax:818-881-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0334021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice