Healthcare Provider Details

I. General information

NPI: 1699891663
Provider Name (Legal Business Name): DAVID A WEAVER,DMD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 NORTHCREEK BLVD
GOODLETTSVILLE TN
37072-1911
US

IV. Provider business mailing address

133 NORTHCREEK BLVD
GOODLETTSVILLE TN
37072-1911
US

V. Phone/Fax

Practice location:
  • Phone: 615-859-7117
  • Fax: 615-851-3535
Mailing address:
  • Phone: 615-859-7117
  • Fax: 615-851-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7247
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID A WEAVER
Title or Position: OWNER
Credential: DMD
Phone: 615-859-7117