Provider Demographics
NPI:1437281094
Name:DOUGLAS S WEAVER DDS APC
Entity Type:Organization
Organization Name:DOUGLAS S WEAVER DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-586-3220
Mailing Address - Street 1:326 4TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1167
Mailing Address - Country:US
Mailing Address - Phone:907-586-3220
Mailing Address - Fax:907-586-2905
Practice Address - Street 1:326 4TH ST STE 205
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1167
Practice Address - Country:US
Practice Address - Phone:907-586-3220
Practice Address - Fax:907-586-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1447226360OtherNPI PROVIDER ENUMERATOR
AKDD0492Medicaid