MEDICARE: DR. ANDREW JOHN WEBER DMD, MS

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	1223P0300X	Periodontics	016067	MO

General Provider Information

NPI Number	:	1548300627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW JOHN WEBER DMD, MS

Provider Business Mailing Address
First Line	:	4450 LOCKHILL SELMA RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4394
Country	:	US
Telephone Number	:	210-496-5603
Fax Number	:	210-496-1286

Provider Business Practice Location Address
First Line	:	4450 LOCKHILL SELMA RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4394
Country	:	US
Telephone Number	:	210-496-5603
Fax Number	:	210-496-1286

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	03/30/2023

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