Provider Demographics
NPI:1982727657
Name:WEIDEMAN, EDWARD MARC (DMD, MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MARC
Last Name:WEIDEMAN
Suffix:
Gender:M
Credentials:DMD, MD
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Other - Credentials:
Mailing Address - Street 1:9094 E MINERAL AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-768-8570
Mailing Address - Fax:303-768-8572
Practice Address - Street 1:9094 E MINERAL AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-768-8570
Practice Address - Fax:303-768-8572
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO96261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery