Healthcare Provider Details

I. General information

NPI: 1073709226
Provider Name (Legal Business Name): WEBER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S WOODS MILL RD STE 720N
CHESTERFIELD MO
63017-3650
US

IV. Provider business mailing address

222 S WOODS MILL RD STE 720N
CHESTERFIELD MO
63017-3650
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-0493
  • Fax: 314-434-7883
Mailing address:
  • Phone: 314-434-0493
  • Fax: 314-434-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DONNA MARIE GRAESER
Title or Position: INSURANCE
Credential:
Phone: 314-434-0493