1285703140 NPI number — DR. ALLEN MARSHALL WEINBERGER DDS

Table of content: DR. ALLEN MARSHALL WEINBERGER DDS (NPI 1285703140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285703140 NPI number — DR. ALLEN MARSHALL WEINBERGER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINBERGER
Provider First Name:
ALLEN
Provider Middle Name:
MARSHALL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285703140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 S LIVERNOIS
Provider Second Line Business Mailing Address:
SUITE #165
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-651-0730
Provider Business Mailing Address Fax Number:
248-651-0585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 S LIVERNOIS
Provider Second Line Business Practice Location Address:
SUITE #165
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-651-0730
Provider Business Practice Location Address Fax Number:
248-651-0585
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  MI11207 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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