Provider Demographics
NPI:1346461159
Name:WEIBEL, STEPHEN J (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:WEIBEL
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 1:3019 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1321
Mailing Address - Country:US
Mailing Address - Phone:717-898-0220
Mailing Address - Fax:717-898-7941
Practice Address - Street 1:3019 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1321
Practice Address - Country:US
Practice Address - Phone:717-898-0220
Practice Address - Fax:717-898-7941
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO21843-L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics