Provider Demographics
NPI:1770162901
Name:WEINBERG, ALLISON BETH
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:BETH
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 AUDACE AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3384
Mailing Address - Country:US
Mailing Address - Phone:732-832-6741
Mailing Address - Fax:
Practice Address - Street 1:8746 LAKE WORTH RD UNIT 200
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2430
Practice Address - Country:US
Practice Address - Phone:732-832-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN26667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program