Provider Demographics
NPI:1851100127
Name:WEAVER ORTHODONTICS PLLC
Entity type:Organization
Organization Name:WEAVER ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:MONTGOMERY
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-541-2284
Mailing Address - Street 1:127 FAIRWAY DR APT 2
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-9602
Mailing Address - Country:US
Mailing Address - Phone:304-541-2284
Mailing Address - Fax:
Practice Address - Street 1:127 FAIRWAY DR APT 2
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-9602
Practice Address - Country:US
Practice Address - Phone:304-541-2284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental