Provider Demographics
NPI:1972781961
Name:WEBER, DANIEL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:WEBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E WASHINGTON, #1125
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-641-2572
Mailing Address - Fax:312-454-7467
Practice Address - Street 1:25 E WASHINGTON, #1125
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-641-2572
Practice Address - Fax:312-454-7467
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0021841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics