Provider Demographics
NPI:1912972662
Name:WEBER, DAVID M (DDS MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:WEBER
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 TIMBERWOLF PKWY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1218
Mailing Address - Country:US
Mailing Address - Phone:406-755-6014
Mailing Address - Fax:
Practice Address - Street 1:180 TIMBERWOLF PKWY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1218
Practice Address - Country:US
Practice Address - Phone:406-755-6014
Practice Address - Fax:406-755-6094
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12739204E00000X
MT23651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1912972662Medicaid
U97731Medicare UPIN