MEDICARE: BENJAMIN ERIC WEEGE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00010333	WA
2	1223G0001X	General Practice Dentistry	D009102	AZ

General Provider Information

NPI Number	:	1457441842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN ERIC WEEGE DDS

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:	520-616-1537

Provider Business Practice Location Address
First Line	:	899 N WILMOT RD BLDG E
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1714
Country	:	US
Telephone Number	:	520-616-1542
Fax Number	:	520-616-1537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	03/13/2024

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