Provider Demographics
NPI:1356865661
Name:WECKER, NATHAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:A
Last Name:WECKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 W 80TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2139
Mailing Address - Country:US
Mailing Address - Phone:303-421-0641
Mailing Address - Fax:
Practice Address - Street 1:7502 W 80TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2139
Practice Address - Country:US
Practice Address - Phone:303-421-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD106881223G0001X
CODEN.00203967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice