Individual
MICAH WEISENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1144 E FORT UNION BLVD, MIDVALE, UT 84047
(801) 566-3118
Mailing address
1235 E WILMINGTON AVE APT 317, SALT LAKE CITY, UT 84106-4265
(301) 661-1459
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10757585-9922
UT
122300000X
Dentist
15995
MD
Other
Enumeration date
07/23/2015
Last updated
05/22/2018
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