Provider Demographics
NPI:1306981261
Name:WEESE, A. LAMARR (DDA)
Entity type:Individual
Prefix:DR
First Name:A.
Middle Name:LAMARR
Last Name:WEESE
Suffix:
Gender:M
Credentials:DDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 BROWN AVE.
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250
Mailing Address - Country:US
Mailing Address - Phone:304-823-3186
Mailing Address - Fax:
Practice Address - Street 1:609 BROWN AVE. BOX 421
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250
Practice Address - Country:US
Practice Address - Phone:304-823-3186
Practice Address - Fax:304-823-3186
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0137111000Medicaid