Provider Demographics
NPI:1457441842
Name:WEEGE, BENJAMIN ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ERIC
Last Name:WEEGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-616-1537
Practice Address - Street 1:899 N WILMOT RD BLDG E
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1714
Practice Address - Country:US
Practice Address - Phone:520-616-1542
Practice Address - Fax:520-616-1537
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103331223G0001X
AZD0091021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice