MEDICARE: DR. DENNIS J. WEBER II 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN17198	FL

General Provider Information

NPI Number	:	1801806518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS J. WEBER II DMD, MS

Provider Business Mailing Address
First Line	:	1605 COUNTY ROAD 220 STE 110
Second Line	:	ATTN DR. WEBER--ORTHODONTICS
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4909
Country	:	US
Telephone Number	:	904-215-3533
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 COUNTY ROAD 220 STE 110
Second Line	:	ATTN DR. WEBER--ORTHODONTICS
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4909
Country	:	US
Telephone Number	:	904-215-3533
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/29/2014

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