Provider Demographics
NPI:1265894398
Name:WEIDENFELD, ALEX (DMD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:WEIDENFELD
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 1:207 ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-3607
Mailing Address - Country:US
Mailing Address - Phone:845-928-5275
Mailing Address - Fax:
Practice Address - Street 1:207 ROUTE 32
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3607
Practice Address - Country:US
Practice Address - Phone:845-928-5275
Practice Address - Fax:845-928-5276
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02696500122300000X
NY059575122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist