Provider Demographics
NPI:1679122600
Name:WEAVER, ALBA MELISSA (DDS)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:MELISSA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALBA
Other - Middle Name:MELISSA
Other - Last Name:NUNEZ GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALBA WEAVER DDS
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-747-7396
Practice Address - Street 1:1235 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4219
Practice Address - Country:US
Practice Address - Phone:505-425-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARR609361251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty