Provider Demographics
NPI:1205029139
Name:WEBER, DIANA WELLS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:WELLS
Last Name:WEBER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BLDG 38717 38TH STREET
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5660
Mailing Address - Country:US
Mailing Address - Phone:706-787-6927
Mailing Address - Fax:706-787-2082
Practice Address - Street 1:1811 ARMY BLVD
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-221-0826
Practice Address - Fax:706-787-2082
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037167122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist