Provider Demographics
NPI:1770502643
Name:WEAKLAND, PATRICK GREGG (DDS)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:GREGG
Last Name:WEAKLAND
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 1:214 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5109
Mailing Address - Country:US
Mailing Address - Phone:970-686-5544
Mailing Address - Fax:970-686-6872
Practice Address - Street 1:214 5TH ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5109
Practice Address - Country:US
Practice Address - Phone:970-686-5544
Practice Address - Fax:970-686-6872
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO766625OtherUNITED CONCORDIA