MEDICARE: DR. MICHAEL THOMAS WEBER DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7619	NE

General Provider Information

NPI Number	:	1487366225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THOMAS WEBER DDS, MS

Provider Business Mailing Address
First Line	:	2422 S 179TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68130-2687
Country	:	US
Telephone Number	:	402-896-4500
Fax Number	:	402-896-3275

Provider Business Practice Location Address
First Line	:	2422 S 179TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68130-2687
Country	:	US
Telephone Number	:	402-896-4500
Fax Number	:	402-896-3275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2022
Last Update Date	:	03/12/2025

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