MEDICARE: DR. PENNEY WEEKS DMD

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	DN14682	FL

General Provider Information

NPI Number	:	1407897630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNEY WEEKS DMD

Provider Business Mailing Address
First Line	:	228 PONTE VEDRA PARK DR STE 100
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6620
Country	:	US
Telephone Number	:	904-285-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 PONTE VEDRA PARK DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-6613
Country	:	US
Telephone Number	:	904-285-1990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	06/01/2011

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