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General NPI Number Information
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NPI Number | 1851100127
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Entity Type | Organization
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Legal Business Name | WEAVER ORTHODONTICS PLLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 127 FAIRWAY DR APT 2
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City | CORBIN
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State | KY
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Zip | 40701-9602
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Country | US
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Telephone | 304-541-2284
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Fax |
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Provider Business Mailing Address
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Address Line | 127 FAIRWAY DR APT 2
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City | CORBIN
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State | KY
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Zip | 40701-9602
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Country | US
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Telephone | 304-541-2284
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. IAN MONTGOMERY WEAVER
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Credential | DDS
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Telephone | 304-541-2284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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