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General NPI Number Information
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NPI Number | 1366435117
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Entity Type | Individual
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Provider Name | RICHARD LEE WEBER JR. D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 19 JO DOTSON CIR
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City | CLAYTON
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State | GA
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Zip | 30525-5007
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Country | US
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Telephone | 706-212-0294
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Fax |
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Provider Business Mailing Address
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Address Line | 204 LONGVIEW AVE
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City | GAINESVILLE
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State | GA
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Zip | 30501-2223
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Country | US
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Telephone | 770-297-0894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DN009212
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License Number State | GA
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