Provider Demographics
NPI:1730311820
Name:WEBER, GARY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:WEBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:M
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8 W GARTNER RD
Mailing Address - Street 2:SUITE 168
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7521
Mailing Address - Country:US
Mailing Address - Phone:630-420-9090
Mailing Address - Fax:630-420-8081
Practice Address - Street 1:8 W GARTNER RD
Practice Address - Street 2:SUITE 168
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7521
Practice Address - Country:US
Practice Address - Phone:630-420-9090
Practice Address - Fax:630-420-8081
Is Sole Proprietor?:No
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190144301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice