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General NPI Number Information
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NPI Number | 1609181916
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Entity Type | Individual
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Provider Name | ROBERT VINCENT WEAVER DMD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 112 BARTRAM OAKS WALK SUITE #203
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City | ST. JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-264-5437
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Fax | 904-485-8417
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Provider Business Mailing Address
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Address Line | 3020 HARTLEY RD SUITE #120
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City | JACKSONVILLE
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State | FL
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Zip | 32257
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Country | US
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Telephone | 904-264-5437
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Fax | 904-485-8417
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN18975
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 18975
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License Number State | FL
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