Provider Demographics
NPI:1578560009
Name:WEGLARZ, EDMOND FRANK JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:FRANK
Last Name:WEGLARZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7780 CAMBRIDGE MANOR PL
Mailing Address - Street 2:SUITE D
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3656
Mailing Address - Country:US
Mailing Address - Phone:239-275-7722
Mailing Address - Fax:239-275-9662
Practice Address - Street 1:7780 CAMBRIDGE MANOR PL
Practice Address - Street 2:SUITE D
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3656
Practice Address - Country:US
Practice Address - Phone:239-275-7722
Practice Address - Fax:239-275-9662
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN 83951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice