Provider Demographics
NPI:1750320370
Name:WEINGARTNER, GERARD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JOHN
Last Name:WEINGARTNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 80TH ST S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3020
Mailing Address - Country:US
Mailing Address - Phone:651-459-2300
Mailing Address - Fax:651-458-1836
Practice Address - Street 1:7501 80TH ST S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3020
Practice Address - Country:US
Practice Address - Phone:651-459-2300
Practice Address - Fax:651-458-1836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice