Provider Demographics
NPI:1568833382
Name:WEAVER, JOHN KENNETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:WEAVER
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 1:1636 NICHOLASVILLE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1432
Mailing Address - Country:US
Mailing Address - Phone:859-278-0576
Mailing Address - Fax:859-276-2473
Practice Address - Street 1:1636 NICHOLASVILLE RD STE 7
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1432
Practice Address - Country:US
Practice Address - Phone:859-278-0576
Practice Address - Fax:859-276-2473
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY96781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice