Provider Demographics
NPI:1447226360
Name:WEAVER, DOUGLAS S (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:WEAVER
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 1:326 4TH ST
Mailing Address - Street 2:STE 205
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1146
Mailing Address - Country:US
Mailing Address - Phone:907-586-3220
Mailing Address - Fax:907-586-2905
Practice Address - Street 1:326 4TH ST
Practice Address - Street 2:STE 205
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1146
Practice Address - Country:US
Practice Address - Phone:907-586-3220
Practice Address - Fax:907-586-2905
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0492Medicaid
AK1437281094OtherNPI - TYPE 2 #