Healthcare Provider Details

I. General information

NPI: 1346461159
Provider Name (Legal Business Name): STEPHEN J WEIBEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 MARIETTA AVE
LANCASTER PA
17601-1321
US

IV. Provider business mailing address

3019 MARIETTA AVE
LANCASTER PA
17601-1321
US

V. Phone/Fax

Practice location:
  • Phone: 717-898-0220
  • Fax: 717-898-7941
Mailing address:
  • Phone: 717-898-0220
  • Fax: 717-898-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDSO21843-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: