Provider Demographics
NPI:1891812194
Name:WEINER, MARIANNA M (IAO,DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:M
Last Name:WEINER
Suffix:
Gender:F
Credentials:IAO,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1902
Mailing Address - Country:US
Mailing Address - Phone:718-891-0606
Mailing Address - Fax:718-891-1055
Practice Address - Street 1:1738 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1902
Practice Address - Country:US
Practice Address - Phone:718-891-0606
Practice Address - Fax:718-891-1055
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0459131223E0200X, 1223G0001X, 1223P0700X, 1223X0400X, 124Q00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No124Q00000XDental ProvidersDental Hygienist