Provider Demographics
NPI:1689783466
Name:WEBER, CHRISTINA (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5937
Mailing Address - Country:US
Mailing Address - Phone:317-324-4333
Mailing Address - Fax:317-768-0111
Practice Address - Street 1:4960 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5937
Practice Address - Country:US
Practice Address - Phone:317-324-4333
Practice Address - Fax:317-768-0111
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019027049Medicaid