Provider Demographics
NPI:1265406003
Name:WEEDEN, MARILYN MELODY (DMD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:MELODY
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHEROKEE INDIAN HOSPITAL
Mailing Address - Street 2:1 HOSPITAL ROAD
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-9163
Mailing Address - Fax:
Practice Address - Street 1:CHEROKEE INDIAN HOSPITAL
Practice Address - Street 2:1 HOSPITAL ROAD
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900096Medicaid