Healthcare Provider Details

I. General information

NPI: 1487366225
Provider Name (Legal Business Name): MICHAEL THOMAS WEBER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
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 Number7619
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: