Provider Demographics
NPI:1801382866
Name:WEEKS, AUSTEN
Entity Type:Individual
Prefix:
First Name:AUSTEN
Middle Name:
Last Name:WEEKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10125 DEEP CUT RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-8005
Mailing Address - Country:US
Mailing Address - Phone:208-313-2202
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-688-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0039541223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist