Provider Demographics
NPI:1073501672
Name:WEEMS, RONALD DEAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DEAN
Last Name:WEEMS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 BELT LINE RD
Mailing Address - Street 2:SUITE J-K
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4380
Mailing Address - Country:US
Mailing Address - Phone:618-346-2006
Mailing Address - Fax:618-346-2066
Practice Address - Street 1:1099 BELT LINE RD
Practice Address - Street 2:SUITE J-K
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4380
Practice Address - Country:US
Practice Address - Phone:618-346-2006
Practice Address - Fax:618-346-2066
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice