Healthcare Provider Details

I. General information

NPI: 1760489496
Provider Name (Legal Business Name): JOHN STEPHEN WEIR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 ESTATE OFFICE DR
MEMPHIS TN
38119-3635
US

IV. Provider business mailing address

5348 ESTATE OFFICE DR
MEMPHIS TN
38119-3635
US

V. Phone/Fax

Practice location:
  • Phone: 901-763-4700
  • Fax: 901-763-4794
Mailing address:
  • Phone: 901-756-7186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS0000003418
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: