Healthcare Provider Details

I. General information

NPI: 1811060015
Provider Name (Legal Business Name): DR. GARY E WEBER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 VIRGINIA AVE
CONNERSVILLE IN
47331-2834
US

IV. Provider business mailing address

1910 VIRGINIA AVE
CONNERSVILLE IN
47331-2834
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-1121
  • Fax: 765-827-1197
Mailing address:
  • Phone: 765-825-1121
  • Fax: 765-827-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7534
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: