Healthcare Provider Details

I. General information

NPI: 1245855345
Provider Name (Legal Business Name): DAVID M WEBER DDS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TIMBERWOLF PKWY
KALISPELL MT
59901-1218
US

IV. Provider business mailing address

180 TIMBERWOLF PKWY
KALISPELL MT
59901-1218
US

V. Phone/Fax

Practice location:
  • Phone: 406-755-6014
  • Fax:
Mailing address:
  • Phone: 406-755-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DAWN WEBER
Title or Position: ADMINISTRATOR
Credential:
Phone: 406-890-1511