Provider Demographics
NPI:1407897630
Name:WEEKS, PENNEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:PENNEY
Middle Name:
Last Name:WEEKS
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 1:228 PONTE VEDRA PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-6620
Mailing Address - Country:US
Mailing Address - Phone:904-285-1990
Mailing Address - Fax:
Practice Address - Street 1:228 PONTE VEDRA PARK DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6613
Practice Address - Country:US
Practice Address - Phone:904-285-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist