Provider Demographics
NPI:1326593468
Name:WEINBERG, BRIAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:WEINBERG
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 1:1770 1ST ST STE 410
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3237
Mailing Address - Country:US
Mailing Address - Phone:847-432-5520
Mailing Address - Fax:
Practice Address - Street 1:1770 1ST ST STE 410
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3237
Practice Address - Country:US
Practice Address - Phone:847-432-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist