Healthcare Provider Details

I. General information

NPI: 1417162116
Provider Name (Legal Business Name): ZACHARY C. WEBER DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAPITAL BLVD STE 101
ROCKY HILL CT
06067-3914
US

IV. Provider business mailing address

195 SAINT JOHNS RD
RIDGEFIELD CT
06877-5613
US

V. Phone/Fax

Practice location:
  • Phone: 617-271-7262
  • Fax:
Mailing address:
  • Phone: 617-271-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number053288
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12168
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number271496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: