Provider Demographics
NPI:1063197903
Name:WEEKS, TYLER EASON (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:EASON
Last Name:WEEKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 BUTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-6604
Mailing Address - Country:US
Mailing Address - Phone:601-953-1929
Mailing Address - Fax:
Practice Address - Street 1:103 CHRISTIAN DR STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2762
Practice Address - Country:US
Practice Address - Phone:601-953-1929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4392-231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice