Healthcare Provider Details

I. General information

NPI: 1235056995
Provider Name (Legal Business Name): JONATHON PATRICK WEBER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JACK WEBER

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD STE 200
SAINT LOUIS MO
63141-6835
US

IV. Provider business mailing address

3234 COUNTRY KNOLL DR
SAINT CHARLES MO
63303-6370
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-3337
  • Fax:
Mailing address:
  • Phone: 314-315-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026029689
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026029689
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: