Healthcare Provider Details

I. General information

NPI: 1922195395
Provider Name (Legal Business Name): TIMOTHY M WEBER DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIMOTHY M WEBER DMD MD

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S WOODSMILL ROAD SUITE 720 NORTH
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

222 S WOODS MILL RD STE 720
CHESTERFIELD MO
63017-3625
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 TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number15589
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: