Healthcare Provider Details

I. General information

NPI: 1235106634
Provider Name (Legal Business Name): ROBERT J WEBER DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 7TH ST
PROSSER WA
99350
US

IV. Provider business mailing address

711 7TH ST
PROSSER WA
99350
US

V. Phone/Fax

Practice location:
  • Phone: 509-786-1222
  • Fax:
Mailing address:
  • Phone: 509-786-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6505
License Number StateWA

VIII. Authorized Official

Name: ROBERT JOSEPH WEBER
Title or Position: OWNER
Credential: DDS
Phone: 509-786-1222