Provider Demographics
NPI:1770802613
Name:WEEDMAN, SAVANNAH GELESKO (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:GELESKO
Last Name:WEEDMAN
Suffix:
Gender:F
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST FL 3
Mailing Address - Street 2:HEAD AND NECK INSTITUTE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:602-521-5150
Mailing Address - Fax:602-521-5151
Practice Address - Street 1:1441 N 12TH ST FL 3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2837
Practice Address - Country:US
Practice Address - Phone:602-521-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54225207YX0007X, 1223S0112X
NC2022-03116204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery