Provider Demographics
NPI:1720674559
Name:WDW EASTPOINTE PLLC
Entity Type:Organization
Organization Name:WDW EASTPOINTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-777-0260
Mailing Address - Street 1:18501 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3200
Mailing Address - Country:US
Mailing Address - Phone:586-777-0260
Mailing Address - Fax:
Practice Address - Street 1:18501 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3200
Practice Address - Country:US
Practice Address - Phone:586-777-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WDW ROSEVILLE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty