Provider Demographics
NPI:1255402103
Name:WEBER, MAUREEN ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:WEBER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7822
Mailing Address - Country:US
Mailing Address - Phone:903-533-5202
Mailing Address - Fax:
Practice Address - Street 1:1517 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7822
Practice Address - Country:US
Practice Address - Phone:903-533-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14832122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223D0001XDental ProvidersDentistDental Public Health