Healthcare Provider Details

I. General information

NPI: 1023426392
Provider Name (Legal Business Name): ROBERT J WEINSTOCK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VAN DEENE AVE
WEST SPRINGFIELD MA
01089
US

IV. Provider business mailing address

75 VAN DEENE AVE
WEST SPRINGFIELD MA
01089-3258
US

V. Phone/Fax

Practice location:
  • Phone: 413-788-9621
  • Fax: 413-788-0103
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1857534
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11267
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: