Provider Demographics
NPI:1477662666
Name:WEINBERG, ADAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CONVERSE DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6131
Mailing Address - Country:US
Mailing Address - Phone:910-794-2266
Mailing Address - Fax:910-794-6899
Practice Address - Street 1:3505 CONVERSE DR STE 175
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6174
Practice Address - Country:US
Practice Address - Phone:910-794-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC902MAOtherBCBS
NC1345650OtherUNITED CONCORDIA
NC89902MAMedicaid