Provider Demographics
NPI:1013151943
Name:WEAVER, TIMOTHY GARTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GARTH
Last Name:WEAVER
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 1:2554 WOODMEADOW DR SE
Mailing Address - Street 2:STE D
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8033
Mailing Address - Country:US
Mailing Address - Phone:616-942-4010
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-7473
Practice Address - Fax:614-292-7650
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIN PROCESS122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist