Healthcare Provider Details

I. General information

NPI: 1467402453
Provider Name (Legal Business Name): LAURA ANN WEAVER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOUIS JERRY MAYO DDS

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HILL CREST RD
CINCINNATI OH
45224-3226
US

IV. Provider business mailing address

1340 HILL CREST RD
CINCINNATI OH
45224-3226
US

V. Phone/Fax

Practice location:
  • Phone: 513-681-8825
  • Fax: 937-392-4339
Mailing address:
  • Phone: 513-681-8825
  • Fax: 937-392-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18689
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-01-8689
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: