Provider Demographics
NPI:1659668150
Name:WEG, ALIZA CAROLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIZA
Middle Name:CAROLYN
Last Name:WEG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HERRICK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1528
Mailing Address - Country:US
Mailing Address - Phone:516-359-1923
Mailing Address - Fax:
Practice Address - Street 1:32 HERRICK DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1528
Practice Address - Country:US
Practice Address - Phone:516-359-1923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY056173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program