Provider Demographics
NPI:1871591826
Name:WEES, JEROME M (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:M
Last Name:WEES
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 1:14625 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1950
Mailing Address - Country:US
Mailing Address - Phone:402-397-7777
Mailing Address - Fax:402-390-9336
Practice Address - Street 1:14625 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1950
Practice Address - Country:US
Practice Address - Phone:402-397-7777
Practice Address - Fax:402-390-9336
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE52711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE05855OtherBCBS OF NE
NE47054251500Medicaid
IA1922633Medicaid
NE05855OtherBCBS OF NE
267161Medicare PIN