Provider Demographics
NPI:1972716785
Name:MICHAEL T. WEBER DDS, MS, LLC
Entity type:Organization
Organization Name:MICHAEL T. WEBER DDS, MS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:402-896-4500
Mailing Address - Street 1:2422 SOUTH 179TH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2687
Mailing Address - Country:US
Mailing Address - Phone:402-896-4500
Mailing Address - Fax:402-896-3275
Practice Address - Street 1:2422 SOUTH 179TH STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2687
Practice Address - Country:US
Practice Address - Phone:402-896-4500
Practice Address - Fax:402-896-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076927100Medicaid
NE10028773600Medicaid
NE10028782200Medicaid