Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D8267 | OR |
NPI | 1134152663 |
---|---|
Provider Name | Dr. Ted C Weesner |
First Address | West Linn, OR 97008-1718 |
Second Address | West Linn, OR 97008-1718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 13/05/2008 |