Provider Demographics
NPI:1730353012
Name:WILLIAM E. WEGE, DMD LLC
Entity type:Organization
Organization Name:WILLIAM E. WEGE, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-876-2155
Mailing Address - Street 1:124 WEST ML KING JR DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3247
Mailing Address - Country:US
Mailing Address - Phone:912-876-2155
Mailing Address - Fax:912-876-4036
Practice Address - Street 1:110 BAGLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3247
Practice Address - Country:US
Practice Address - Phone:912-876-2155
Practice Address - Fax:912-876-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8306261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center