Healthcare Provider Details

I. General information

NPI: 1720180185
Provider Name (Legal Business Name): MICHAEL DEAN WEEMS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 PORTER AVE
OCEAN SPRINGS MS
39564-3713
US

IV. Provider business mailing address

PO BOX 1588
OCEAN SPRINGS MS
39566-1588
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-8657
  • Fax: 228-818-0013
Mailing address:
  • Phone: 228-875-8657
  • Fax: 228-818-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2845-94
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2845-94
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: