Provider Demographics
NPI:1619958709
Name:WEAVER, KATHERINE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 LAKE WASHINGTON BLVD NE STE 2
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7425
Mailing Address - Country:US
Mailing Address - Phone:425-284-0515
Mailing Address - Fax:
Practice Address - Street 1:5726 LAKE WASHINGTON BLVD NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7425
Practice Address - Country:US
Practice Address - Phone:425-284-0515
Practice Address - Fax:425-284-0516
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA91471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1386001865OtherNPPES