Healthcare Provider Details

I. General information

NPI: 1972716785
Provider Name (Legal Business Name): MICHAEL T. WEBER DDS, MS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 SOUTH 179TH STREET
OMAHA NE
68130-2687
US

IV. Provider business mailing address

2422 SOUTH 179TH STREET
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: MR. MICHAEL T WEBER
Title or Position: OWNER/ORTHODONTIST
Credential: DDS, MS
Phone: 402-896-4500