# DR. JOHN S WEAVER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1508933946
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00005111 | WA | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 08/31/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000843827 | UNITED CONCORDIA PROVIDER | WA |
| 01 | — | 0035126 | L & I PROVIDER NUMBER | WA |
| 05 | — | 5550603 | — | WA |