Provider Demographics
NPI:1316033491
Name:WEISBROD, EARL (DMD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:WEISBROD
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 1:1715 E PALMAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5532
Mailing Address - Country:US
Mailing Address - Phone:602-569-5500
Mailing Address - Fax:
Practice Address - Street 1:3845 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4901
Practice Address - Country:US
Practice Address - Phone:602-956-2050
Practice Address - Fax:602-956-6027
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ69581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice