Provider Demographics
NPI:1932276698
Name:WEBER, BLAKE HUNTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:HUNTER
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 1:7924 CANTRELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LR
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2501
Mailing Address - Country:US
Mailing Address - Phone:501-225-0113
Mailing Address - Fax:501-225-0155
Practice Address - Street 1:7924 CANTRELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:LR
Practice Address - State:AR
Practice Address - Zip Code:72227-2501
Practice Address - Country:US
Practice Address - Phone:501-225-0113
Practice Address - Fax:501-225-0155
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist