Provider Demographics
NPI:1164900452
Name:WEBER, NATALIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23082 RIDGE ROUTE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3691
Mailing Address - Country:US
Mailing Address - Phone:949-837-2766
Mailing Address - Fax:
Practice Address - Street 1:23082 RIDGE ROUTE DR STE A
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3691
Practice Address - Country:US
Practice Address - Phone:949-837-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist