Provider Demographics
NPI:1336229137
Name:WEBER, DOUGLAS BOYD (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BOYD
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:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93584-0592
Mailing Address - Country:US
Mailing Address - Phone:661-945-3661
Mailing Address - Fax:661-942-0155
Practice Address - Street 1:41307 12TH ST W STE 100
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1454
Practice Address - Country:US
Practice Address - Phone:661-267-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist