Basic Information
| Provider Information | |||||||||
| NPI: | 1265406003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEEDEN | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | MELODY | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CHEROKEE INDIAN HOSPITAL | ||||||||
| Address2: | 1 HOSPITAL ROAD | ||||||||
| City: | CHEROKEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284979163 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CHEROKEE INDIAN HOSPITAL | ||||||||
| Address2: | 1 HOSPITAL ROAD | ||||||||
| City: | CHEROKEE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284979163 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 10/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN15513 | FL | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 5900096 | 05 | NC | MEDICAID |