Provider Demographics
NPI:1255439170
Name:WEBER, GREGORY JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
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 1:3510 HOBSON RD
Mailing Address - Street 2:#103
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1440
Mailing Address - Country:US
Mailing Address - Phone:630-964-4890
Mailing Address - Fax:630-964-4905
Practice Address - Street 1:3510 HOBSON RD
Practice Address - Street 2:#103
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1440
Practice Address - Country:US
Practice Address - Phone:630-964-4890
Practice Address - Fax:630-964-4905
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice