Provider Demographics
NPI:1841341567
Name:WEBER, CALVIN A (DDS)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:A
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 1:946 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1834
Mailing Address - Country:US
Mailing Address - Phone:712-527-2150
Mailing Address - Fax:712-527-3360
Practice Address - Street 1:946 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1834
Practice Address - Country:US
Practice Address - Phone:712-527-2150
Practice Address - Fax:712-527-3360
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0212704Medicaid