Provider Demographics
NPI:1811077373
Name:WEINBERG, SUSAN KAY (DMD)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:KAY
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 SW SHADY LN
Mailing Address - Street 2:SUITE #307
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5481
Mailing Address - Country:US
Mailing Address - Phone:503-968-1696
Mailing Address - Fax:503-684-9808
Practice Address - Street 1:9735 SW SHADY LN
Practice Address - Street 2:SUITE #307
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5481
Practice Address - Country:US
Practice Address - Phone:503-968-1696
Practice Address - Fax:503-684-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist