Provider Demographics
NPI:1699223446
Name:WEIBEL, PAUL EDWIN (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWIN
Last Name:WEIBEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1398
Mailing Address - Country:US
Mailing Address - Phone:717-898-0220
Mailing Address - Fax:
Practice Address - Street 1:3019 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1398
Practice Address - Country:US
Practice Address - Phone:717-898-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist