Provider Demographics
NPI:1912079583
Name:WEBER, MATHIAS J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATHIAS
Middle Name:J
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 1:17585 W NORTH AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4365
Mailing Address - Country:US
Mailing Address - Phone:262-782-7120
Mailing Address - Fax:262-782-0656
Practice Address - Street 1:17585 W NORTH AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4365
Practice Address - Country:US
Practice Address - Phone:262-782-7120
Practice Address - Fax:262-782-0656
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4628-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice