Healthcare Provider Details

I. General information

NPI: 1043319882
Provider Name (Legal Business Name): THOMAS J WEBER DDS, MS, PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 S 179TH ST
OMAHA NE
68130-2687
US

IV. Provider business mailing address

2422 S 179TH ST
OMAHA NE
68130-2687
US

V. Phone/Fax

Practice location:
  • Phone: 402-896-4500
  • Fax: 402-896-3275
Mailing address:
  • Phone: 402-896-4500
  • Fax: 402-896-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5754
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: