Healthcare Provider Details

I. General information

NPI: 1073501672
Provider Name (Legal Business Name): RONALD DEAN WEEMS JR. D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

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

III. Provider practice location address

1099 BELT LINE RD SUITE J-K
COLLINSVILLE IL
62234-4380
US

IV. Provider business mailing address

1099 BELT LINE RD SUITE J-K
COLLINSVILLE IL
62234-4380
US

V. Phone/Fax

Practice location:
  • Phone: 618-346-2006
  • Fax: 618-346-2066
Mailing address:
  • Phone: 618-346-2006
  • Fax: 618-346-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: