Provider Demographics
NPI:1629157847
Name:WEAVER, KARL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:DAVID
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 1:5100 EASTPARK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-2149
Mailing Address - Country:US
Mailing Address - Phone:608-222-8232
Mailing Address - Fax:608-222-8340
Practice Address - Street 1:5100 EASTPARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2149
Practice Address - Country:US
Practice Address - Phone:608-222-8232
Practice Address - Fax:608-222-8340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice