Provider Demographics
NPI:1780813006
Name:WEAVER, JONATHAN S (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:WEAVER
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 1:12350 INDUSTRY WAY
Mailing Address - Street 2:STE 210
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4301
Mailing Address - Country:US
Mailing Address - Phone:907-345-7722
Mailing Address - Fax:907-345-6734
Practice Address - Street 1:2600 DENALI ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2746
Practice Address - Country:US
Practice Address - Phone:907-277-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice