Provider Demographics
NPI:1356977136
Name:CHARYL WEINGARTEN, D.D.S., P.L.L.C
Entity type:Organization
Organization Name:CHARYL WEINGARTEN, D.D.S., P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-791-8563
Mailing Address - Street 1:591 APOLLO DR
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-3005
Mailing Address - Country:US
Mailing Address - Phone:651-786-7630
Mailing Address - Fax:
Practice Address - Street 1:591 APOLLO DR
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-3005
Practice Address - Country:US
Practice Address - Phone:651-786-7630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINO LAKES FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty