Provider Demographics
NPI:1871839498
Name:EDWARD J. WEISBERG,D.D.S.
Entity Type:Organization
Organization Name:EDWARD J. WEISBERG,D.D.S.
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-440-0044
Mailing Address - Street 1:900 W LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2024
Mailing Address - Country:US
Mailing Address - Phone:757-440-0044
Mailing Address - Fax:757-440-0092
Practice Address - Street 1:801 W LITTLE CREEK RD STE 103
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2036
Practice Address - Country:US
Practice Address - Phone:757-440-0044
Practice Address - Fax:757-961-6882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-31
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007805411Medicaid