Healthcare Provider Details

I. General information

NPI: 1487643789
Provider Name (Legal Business Name): DR. DONALD BENJAMIN WEEKS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: DONALD B WEEKS DMD

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DURHAM RD SUITE 32
MADISON CT
06443-2677
US

IV. Provider business mailing address

149 DURHAM RD SUITE 32
MADISON CT
06443-2677
US

V. Phone/Fax

Practice location:
  • Phone: 203-245-6985
  • Fax:
Mailing address:
  • Phone: 203-245-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number005497
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: