Provider Demographics
NPI:1326872862
Name:MARK W WEEMS DDS PC
Entity type:Organization
Organization Name:MARK W WEEMS DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-482-1070
Mailing Address - Street 1:316 S RENNIE ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6537
Mailing Address - Country:US
Mailing Address - Phone:580-332-9447
Mailing Address - Fax:
Practice Address - Street 1:316 S RENNIE ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6537
Practice Address - Country:US
Practice Address - Phone:580-332-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty