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General NPI Number Information
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NPI Number | 1174731012
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Entity Type | Organization
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Legal Business Name | WEILBACHER DENTAL CARE
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2321 DRUSILLA LANE SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70809-1464
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Country | US
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Telephone | 225-928-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 2321 DRUSILLA LANE SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70809-1464
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Country | US
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Telephone | 225-928-3384
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN JOHN WEILBACHER
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Credential | DDS
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Telephone | 225-928-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2924
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License Number State | LA
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