MEDICARE: WILLIAM J WEAVER DMD

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	DS17899	PA

General Provider Information

NPI Number	:	1649232364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J WEAVER DMD

Provider Business Mailing Address
First Line	:	123 MAIN ST
Second Line	:
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-1212
Country	:	US
Telephone Number	:	814-849-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 MAIN ST
Second Line	:
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-1212
Country	:	US
Telephone Number	:	814-849-2652
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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