Provider Demographics
NPI:1851392633
Name:WEEDON, STACY I (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:I
Last Name:WEEDON
Suffix:
Gender:F
Credentials:DDS
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Other - Credentials:
Mailing Address - Street 1:720 ROUTE 202-206 N
Mailing Address - Street 2:GREEN KNOLL PROF'L PARK BUILDING 2
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-707-1133
Mailing Address - Fax:908-707-4665
Practice Address - Street 1:720 ROUTE 202-206 N
Practice Address - Street 2:GREEN KNOLL PROF'L PARK BUILDING 2
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-707-1133
Practice Address - Fax:908-707-4665
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22DI017960001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry