Provider Demographics
NPI:1730476615
Name:WEINER, AVRAHAM A (DMD)
Entity Type:Individual
Prefix:DR
First Name:AVRAHAM
Middle Name:A
Last Name:WEINER
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 1:7300 CITY AVE RM 350
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2245
Mailing Address - Country:US
Mailing Address - Phone:215-877-0900
Mailing Address - Fax:
Practice Address - Street 1:7300 CITY AVE RM 350
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2245
Practice Address - Country:US
Practice Address - Phone:215-877-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0398771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice