Provider Demographics
NPI:1174960215
Name:BRETT WEEDON, DDS, P.A.
Entity type:Organization
Organization Name:BRETT WEEDON, DDS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:EVERETTE
Authorized Official - Last Name:WEEDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-807-9284
Mailing Address - Street 1:198 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-620-1117
Mailing Address - Fax:301-620-9768
Practice Address - Street 1:198 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-620-1117
Practice Address - Fax:301-620-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty