Healthcare Provider Details

I. General information

NPI: 1548300627
Provider Name (Legal Business Name): ANDREW JOHN WEBER DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 LOCKHILL SELMA RD STE 101
SAN ANTONIO TX
78249-4394
US

IV. Provider business mailing address

4450 LOCKHILL SELMA RD STE 101
SAN ANTONIO TX
78249-4394
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-5603
  • Fax: 210-496-1286
Mailing address:
  • Phone: 210-496-5603
  • Fax: 210-496-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number016067
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: