Healthcare Provider Details

I. General information

NPI: 1326533209
Provider Name (Legal Business Name): CHRISTINA WEAVER FARRELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA ANN WEAVER DDS

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ANNA AVE
BLANDON PA
19510
US

IV. Provider business mailing address

PO BOX 260
BLANDON PA
19510
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-1233
  • Fax: 610-916-7640
Mailing address:
  • Phone: 610-926-1233
  • Fax: 610-916-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042101
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: