Provider Demographics
NPI:1568595130
Name:KURT K. WEBER, D.D.S., P.A.
Entity Type:Organization
Organization Name:KURT K. WEBER, D.D.S., P.A.
Other - Org Name:SEFFNER MANGO DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:KENTON
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-689-9100
Mailing Address - Street 1:1012 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4572
Mailing Address - Country:US
Mailing Address - Phone:813-689-9100
Mailing Address - Fax:813-653-4990
Practice Address - Street 1:1012 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4572
Practice Address - Country:US
Practice Address - Phone:813-689-9100
Practice Address - Fax:813-653-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10991261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental