Provider Demographics
NPI:1013043348
Name:WEAKS, L MARILYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:MARILYN
Last Name:WEAKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S NEW BALLAS ROAD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-344-1106
Mailing Address - Fax:314-344-1177
Practice Address - Street 1:3394 MCKELVEY ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-1106
Practice Address - Fax:314-344-1177
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist