Provider Demographics
NPI:1275345035
Name:WEEDMAN DENTAL PLLC
Entity type:Organization
Organization Name:WEEDMAN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKAELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-680-0322
Mailing Address - Street 1:9959 BLACKHORSE RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-9781
Mailing Address - Country:US
Mailing Address - Phone:602-680-0322
Mailing Address - Fax:
Practice Address - Street 1:710 N BEAVER ST BLDG 5
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3146
Practice Address - Country:US
Practice Address - Phone:928-774-4726
Practice Address - Fax:833-895-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental