Provider Demographics
NPI:1336141217
Name:WEBER, KEVIN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
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 1:21ST DENTAL COMPANY
Mailing Address - Street 2:BOX 63037
Mailing Address - City:MCBH KANEOHE BAY
Mailing Address - State:HI
Mailing Address - Zip Code:96863
Mailing Address - Country:US
Mailing Address - Phone:808-257-3100
Mailing Address - Fax:808-257-5691
Practice Address - Street 1:21ST DENTAL COMPANY
Practice Address - Street 2:BOX 63037
Practice Address - City:MCBH KANEOHE BAY
Practice Address - State:HI
Practice Address - Zip Code:96863
Practice Address - Country:US
Practice Address - Phone:808-257-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3489-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice