Provider Demographics
NPI:1851547848
Name:MARK D WEINHOLD D D S P C
Entity Type:Organization
Organization Name:MARK D WEINHOLD D D S P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEINHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-786-2185
Mailing Address - Street 1:1 E COUNTYLINE RD
Mailing Address - Street 2:STE A
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2178
Mailing Address - Country:US
Mailing Address - Phone:815-786-2185
Mailing Address - Fax:815-786-7014
Practice Address - Street 1:1 E COUNTYLINE RD
Practice Address - Street 2:STE A
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2178
Practice Address - Country:US
Practice Address - Phone:815-786-2185
Practice Address - Fax:815-786-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty