Provider Demographics
NPI:1073709226
Name:WEBER DDS PC
Entity Type:Organization
Organization Name:WEBER DDS PC
Other - Org Name:ST LOUIS COUNTY ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-434-0493
Mailing Address - Street 1:222 S WOODS MILL RD STE 720N
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3650
Mailing Address - Country:US
Mailing Address - Phone:314-434-0493
Mailing Address - Fax:314-434-7883
Practice Address - Street 1:222 S WOODS MILL RD STE 720N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3650
Practice Address - Country:US
Practice Address - Phone:314-434-0493
Practice Address - Fax:314-434-7883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEBER DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-21
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT70978Medicare UPIN
MO000020165Medicare PIN
MO990001042Medicare PIN