MEDICARE: DR DANIEL ANDREW WEAVER PROFESSIONAL DENTAL CORPORATION CENTER FOR RESTORATIVE DENTISTRY

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1528922036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR DANIEL ANDREW WEAVER PROFESSIONAL DENTAL CORPORATION CENTER FOR RESTORATIVE DENTISTRY

Provider Business Mailing Address
First Line	:	715 W COLLEGE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-1523
Country	:	US
Telephone Number	:	337-478-3123
Fax Number	:	337-504-7875

Provider Business Practice Location Address
First Line	:	715 W COLLEGE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-1523
Country	:	US
Telephone Number	:	337-478-3123
Fax Number	:	337-504-7875

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DANIEL WEAVER
Credential	:	DDS
Telephone Number	:	337-478-3123

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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