Provider Demographics
NPI:1922019934
Name:WEAVER, ADAM FRED (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:FRED
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E PRENTICE AVE
Mailing Address - Street 2:D-7
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2744
Mailing Address - Country:US
Mailing Address - Phone:303-740-0080
Mailing Address - Fax:303-740-7481
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:D-7
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2744
Practice Address - Country:US
Practice Address - Phone:303-740-0080
Practice Address - Fax:303-740-7481
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist