Healthcare Provider Details

I. General information

NPI: 1003028846
Provider Name (Legal Business Name): ALLEN L WEINER, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PARK ST
MEDFIELD MA
02052-2518
US

IV. Provider business mailing address

16 PARK ST PO BOX 276
MEDFIELD MA
02052-2518
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-2321
  • Fax: 508-359-2328
Mailing address:
  • Phone: 508-359-2321
  • Fax: 508-359-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number11026
License Number StateMA

VIII. Authorized Official

Name: DR. ALLEN L WEINER
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 508-359-2321