Provider Demographics
NPI:1760489496
Name:WEIR, JOHN STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:WEIR
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 1:5348 ESTATE OFFICE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3635
Mailing Address - Country:US
Mailing Address - Phone:901-756-7186
Mailing Address - Fax:
Practice Address - Street 1:5348 ESTATE OFFICE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3635
Practice Address - Country:US
Practice Address - Phone:901-763-4700
Practice Address - Fax:901-763-4794
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000034181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics