MEDICARE: AUSTEN WEEKS

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	1223D0004X	Dental Anesthesiology	RES.003954	OH
2	1223D0004X	Dental Anesthesiology	D-DA-5225	ID
3	1223G0001X	General Practice Dentistry	D-DA-5225	ID

General Provider Information

NPI Number	:	1801382866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTEN WEEKS

Provider Business Mailing Address
First Line	:	10125 DEEP CUT RD NE
Second Line	:
City	:	MILLERSPORT
State	:	OH
Zip	:	43046-8005
Country	:	US
Telephone Number	:	208-313-2202
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W 12TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-688-3763
Fax Number	:

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

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	05/02/2025

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