Provider Demographics
NPI:1043319882
Name:WEBER, THOMAS J (DDS, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:WEBER
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 S 179TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2687
Mailing Address - Country:US
Mailing Address - Phone:402-896-4500
Mailing Address - Fax:402-896-3275
Practice Address - Street 1:2422 S 179TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2687
Practice Address - Country:US
Practice Address - Phone:402-896-4500
Practice Address - Fax:402-896-3275
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076927100Medicaid