Provider Demographics
NPI:1881997070
Name:WEBER FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:WEBER FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-263-3965
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009
Mailing Address - Country:US
Mailing Address - Phone:507-263-3965
Mailing Address - Fax:507-263-9485
Practice Address - Street 1:925 4TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009
Practice Address - Country:US
Practice Address - Phone:507-263-3965
Practice Address - Fax:507-263-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty