Provider Demographics
NPI:1659934735
Name:WEIDBERG, DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:WEIDBERG
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 1:122 PROFESSIONAL VIEW DR BLDG 100
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7902
Mailing Address - Country:US
Mailing Address - Phone:732-625-8080
Mailing Address - Fax:
Practice Address - Street 1:122 PROFESSIONAL VIEW DR BLDG 100
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7902
Practice Address - Country:US
Practice Address - Phone:732-625-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02821400122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program