Provider Demographics
NPI:1558309161
Name:JEFFREY M WEINER DDS PC
Entity Type:Organization
Organization Name:JEFFREY M WEINER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-632-1612
Mailing Address - Street 1:3254 RED LION RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1109
Mailing Address - Country:US
Mailing Address - Phone:215-632-1612
Mailing Address - Fax:215-632-3221
Practice Address - Street 1:3254 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1109
Practice Address - Country:US
Practice Address - Phone:215-632-1612
Practice Address - Fax:215-632-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019951L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA421589OtherUNITED CONCORDIA ID
PA=========OtherTAX IDENTIFICATION NUMBER