# AWL DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advantage Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437435781
- **Authorized official:** DR. JAMES R WEAVER DDS (PRESIDENT)
- **Authorized official phone:** (208) 284-0054

## Contact information

- **Practice address:** 170 S CREASY LN STE 1730, LAFAYETTE, IN 47905-0759
- **Practice address phone:** (765) 913-9070
- **Mailing address:** 3974 BELL CT, NAMPA, ID 83686-1411
- **Mailing address phone:** (208) 284-0054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011732A | IN | Yes |

## Other

- **Enumeration date:** 11/01/2011
- **Last updated:** 11/01/2011