Provider Demographics
NPI:1538164967
Name:WEEKS, GARY DAWAYNE (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DAWAYNE
Last Name:WEEKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5940
Mailing Address - Country:US
Mailing Address - Phone:979-297-6438
Mailing Address - Fax:979-297-4644
Practice Address - Street 1:103 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5940
Practice Address - Country:US
Practice Address - Phone:979-297-6438
Practice Address - Fax:979-297-4644
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice