Provider Demographics
NPI:1922592781
Name:WEAVER, ROXANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:WEAVER
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 1:1027 30TH ST S APT E2
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1143
Mailing Address - Country:US
Mailing Address - Phone:256-694-1958
Mailing Address - Fax:
Practice Address - Street 1:716 32ND ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3500
Practice Address - Country:US
Practice Address - Phone:205-326-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL65151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice