Provider Demographics
NPI:1851431563
Name:WEIL, JEFFREY MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARC
Last Name:WEIL
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 1:240 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:03070
Mailing Address - Country:US
Mailing Address - Phone:201-460-1333
Mailing Address - Fax:201-460-0117
Practice Address - Street 1:240 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:03070
Practice Address - Country:US
Practice Address - Phone:201-460-1333
Practice Address - Fax:201-460-0117
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ94671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics