Provider Demographics
NPI:1710011531
Name:WEENIG, DUANE ROBERT (DDS, MS)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:ROBERT
Last Name:WEENIG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 WELLINGTON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6126
Mailing Address - Country:US
Mailing Address - Phone:970-243-9640
Mailing Address - Fax:970-242-2655
Practice Address - Street 1:790 WELLINGTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6126
Practice Address - Country:US
Practice Address - Phone:970-243-9640
Practice Address - Fax:970-242-2655
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics