Provider Demographics
NPI:1972851772
Name:WEBER, RICHARD J (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:WEBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 ROUTE 206
Mailing Address - Street 2:UNIT D
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088
Mailing Address - Country:US
Mailing Address - Phone:609-801-2486
Mailing Address - Fax:609-801-2565
Practice Address - Street 1:16A ORCHARD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3993
Practice Address - Country:US
Practice Address - Phone:856-979-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025156001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice