MEDICARE: DR BRIAN M WEINERG DMD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1376241927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BRIAN M WEINERG DMD LTD

Provider Business Mailing Address
First Line	:	1770 1ST ST STE 410
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3237
Country	:	US
Telephone Number	:	847-432-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 1ST ST STE 410
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3237
Country	:	US
Telephone Number	:	847-432-5520
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN M WEINBERG
Credential	:	DMD
Telephone Number	:	847-432-5520

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	09/25/2023

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