Provider Demographics
NPI:1225656929
Name:WEBER, DYLAN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JAMES
Last Name:WEBER
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 1:78 PHILLIPS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3451
Mailing Address - Country:US
Mailing Address - Phone:417-699-3850
Mailing Address - Fax:
Practice Address - Street 1:228 WASHINGTON ST STE 140
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5563
Practice Address - Country:US
Practice Address - Phone:774-206-5592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18587331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADN1858733OtherMASSACHUSETTS BOARD OF REGISTRATION IN DENTISTRY