Provider Demographics
NPI:1982699617
Name:WEBER, CHARLES ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:WEBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E MARSHALL ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4467
Mailing Address - Country:US
Mailing Address - Phone:610-436-5161
Mailing Address - Fax:610-430-0945
Practice Address - Street 1:606 E MARSHALL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4467
Practice Address - Country:US
Practice Address - Phone:610-436-5161
Practice Address - Fax:610-430-0945
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA173761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice