Provider Demographics
NPI:1902052582
Name:GREGORY W WEAKLEY DDS PA
Entity Type:Organization
Organization Name:GREGORY W WEAKLEY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-662-9133
Mailing Address - Street 1:84 THOMAS JOHNSON CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4348
Mailing Address - Country:US
Mailing Address - Phone:301-662-9133
Mailing Address - Fax:301-694-2941
Practice Address - Street 1:84 THOMAS JOHNSON CT
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-662-9133
Practice Address - Fax:301-694-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty