Provider Demographics
NPI:1942349782
Name:WEINBERG, MARTIN (DMD,PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DMD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OAKWYNNE DR
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2304
Mailing Address - Country:US
Mailing Address - Phone:610-649-4192
Mailing Address - Fax:
Practice Address - Street 1:1518 WALNUT ST
Practice Address - Street 2:SUITE1101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3419
Practice Address - Country:US
Practice Address - Phone:215-732-0505
Practice Address - Fax:215-732-8744
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0188801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice