Provider Demographics
NPI:1720180185
Name:WEEMS, MICHAEL DEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:WEEMS
Suffix:
Gender:M
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:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-1588
Mailing Address - Country:US
Mailing Address - Phone:228-875-8657
Mailing Address - Fax:228-818-0013
Practice Address - Street 1:399 PORTER AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3713
Practice Address - Country:US
Practice Address - Phone:228-875-8657
Practice Address - Fax:228-818-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2845-94124Q00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist