Healthcare Provider Details

I. General information

NPI: 1831563832
Provider Name (Legal Business Name): JEFFREY THOMAS WEBER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2015
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W SUNSET BLVD STE 6D
LOS ANGELES CA
90027-5814
US

IV. Provider business mailing address

426 S SEPULVEDA BLVD APT 301
LOS ANGELES CA
90049-3556
US

V. Phone/Fax

Practice location:
  • Phone: 480-444-8272
  • Fax:
Mailing address:
  • Phone: 480-444-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009135
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDDS108250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: