Provider Demographics
NPI:1922146133
Name:WEINER, LAWRENCE E (DMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:WEINER
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 1:374 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1975
Mailing Address - Country:US
Mailing Address - Phone:201-891-5424
Mailing Address - Fax:201-847-1264
Practice Address - Street 1:374 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1975
Practice Address - Country:US
Practice Address - Phone:201-891-5424
Practice Address - Fax:201-847-1264
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 195101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice