Healthcare Provider Details

I. General information

NPI: 1497711089
Provider Name (Legal Business Name): NADIA MARADIAGA WEBER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADIA L MARADIAGA DDS

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 4TH STREET SOUTH
CANNON FALLS MN
55009
US

IV. Provider business mailing address

PO BOX 15
CANNON FALLS MN
55009
US

V. Phone/Fax

Practice location:
  • Phone: 507-263-3965
  • Fax: 651-457-8574
Mailing address:
  • Phone: 507-263-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12169
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12169
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: