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General NPI Number Information
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NPI Number | 1467629527
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Entity Type | Organization
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Legal Business Name | TED C WEESNER, DDS
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 18676 WILLAMETTE DR STE 303
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City | WEST LINN
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State | OR
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Zip | 97068-1718
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Country | US
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Telephone | 503-636-7010
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Fax | 503-636-9851
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Provider Business Mailing Address
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Address Line | 18676 WILLAMETTE DR STE 303
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City | WEST LINN
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State | OR
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Zip | 97068-1718
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Country | US
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Telephone | 503-636-7010
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Fax | 503-636-9851
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PAULA L ANDERSON
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Credential |
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Telephone | 503-636-7010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D8267
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License Number State | OR
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