Provider Demographics
NPI:1679660526
Name:WEAVER, DAVID A (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
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 1:127 ASHLAND PT
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5506
Mailing Address - Country:US
Mailing Address - Phone:615-826-9197
Mailing Address - Fax:
Practice Address - Street 1:133 NORTHCREEK BLVD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1911
Practice Address - Country:US
Practice Address - Phone:615-859-7117
Practice Address - Fax:615-851-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice