MEDICARE: LAURA ANN WEAVER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-01-8689	OH
2	122300000X	Dentist	18689	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467402453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN WEAVER DDS

Provider Business Mailing Address
First Line	:	1340 HILL CREST RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3226
Country	:	US
Telephone Number	:	513-681-8825
Fax Number	:	937-392-4339

Provider Business Practice Location Address
First Line	:	1340 HILL CREST RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3226
Country	:	US
Telephone Number	:	513-681-8825
Fax Number	:	937-392-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/03/2014

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