Provider Demographics
NPI:1972359370
Name:WEINGARTEN DDS INC
Entity type:Organization
Organization Name:WEINGARTEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLYNNE
Authorized Official - Middle Name:V
Authorized Official - Last Name:WEINGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-303-2533
Mailing Address - Street 1:4213 FARMDALE AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2939
Mailing Address - Country:US
Mailing Address - Phone:157-430-3253
Mailing Address - Fax:
Practice Address - Street 1:12660 RIVERSIDE DR STE 210
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3430
Practice Address - Country:US
Practice Address - Phone:818-284-6018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental