Provider Demographics
NPI:1386881431
Name:RICHARD C. WEBER, D.D.S., LLC
Entity type:Organization
Organization Name:RICHARD C. WEBER, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-849-0421
Mailing Address - Street 1:9780 LANTERN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4092
Mailing Address - Country:US
Mailing Address - Phone:317-849-0421
Mailing Address - Fax:317-849-0425
Practice Address - Street 1:9780 LANTERN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4092
Practice Address - Country:US
Practice Address - Phone:317-849-0421
Practice Address - Fax:317-849-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120079101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1386745792OtherNPI TYPE 1
IN12007910OtherIN DENTIST LICENSE