Provider Demographics
NPI:1073679080
Name:RONALD D WEAKS DDS INC
Entity Type:Organization
Organization Name:RONALD D WEAKS DDS INC
Other - Org Name:LONGBRANCH DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEAKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-455-4161
Mailing Address - Street 1:4250 JOE RAMSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401
Mailing Address - Country:US
Mailing Address - Phone:903-455-4161
Mailing Address - Fax:903-455-7510
Practice Address - Street 1:4250 JOE RAMSEY BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:903-455-4161
Practice Address - Fax:903-455-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty