Healthcare Provider Details

I. General information

NPI: 1962425538
Provider Name (Legal Business Name): DANIEL A WEAVER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W COLLEGE ST
LAKE CHARLES LA
70605-1523
US

IV. Provider business mailing address

715 W COLLEGE ST
LAKE CHARLES LA
70605-1523
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-3123
  • Fax: 337-478-3229
Mailing address:
  • Phone: 337-478-3123
  • Fax: 337-478-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5219
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: