Healthcare Provider Details

I. General information

NPI: 1255402103
Provider Name (Legal Business Name): MAUREEN ELIZABETH WEBER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 W FRONT ST
TYLER TX
75702-7822
US

IV. Provider business mailing address

1517 W FRONT ST
TYLER TX
75702-7822
US

V. Phone/Fax

Practice location:
  • Phone: 903-533-5202
  • Fax:
Mailing address:
  • Phone: 903-533-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14832
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number14832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: