Provider Demographics
NPI:1134152663
Name:WEESNER, TED C (DDS)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:C
Last Name:WEESNER
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 1:18676 WILLAMETTE DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97008-1718
Mailing Address - Country:US
Mailing Address - Phone:503-636-7010
Mailing Address - Fax:503-636-9851
Practice Address - Street 1:18676 WILLAMETTE DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97008-1718
Practice Address - Country:US
Practice Address - Phone:503-636-7010
Practice Address - Fax:503-636-9851
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD82671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics