Provider Demographics
NPI:1760730329
Name:WEISBERGER, AARON JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:JACOB
Last Name:WEISBERGER
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 1:155 KALE CT
Mailing Address - Street 2:
Mailing Address - City:ST. ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584
Mailing Address - Country:US
Mailing Address - Phone:231-420-6111
Mailing Address - Fax:
Practice Address - Street 1:155 KALE CT
Practice Address - Street 2:
Practice Address - City:ST. ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584
Practice Address - Country:US
Practice Address - Phone:231-420-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist