Provider Demographics
NPI:1598138612
Name:WEINBERG, JACOB ERNEST (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ERNEST
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SW MOODY AVE
Mailing Address - Street 2:MAIL CODE: SD-PERI
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5042
Mailing Address - Country:US
Mailing Address - Phone:503-494-1352
Mailing Address - Fax:503-494-5777
Practice Address - Street 1:2730 SW MOODY AVE
Practice Address - Street 2:MAIL CODE: SD-PERI
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5042
Practice Address - Country:US
Practice Address - Phone:503-494-1352
Practice Address - Fax:503-494-5777
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD40901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics