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Organization
BROOKVILLE DENTAL PC
Active
Organization
BROOKVILLE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM J WEAVER D.M.D. (PRESIDENT)
(814) 849-2652
Entity
Organization
Contact information
Practice address
123 MAIN ST, BROOKVILLE, PA 15825-1212
(814) 849-2652
Mailing address
123 MAIN ST, BROOKVILLE, PA 15825-1212
(814) 849-2652
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS024744L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018235500001
—
PA
Enumeration date
07/27/2006
Last updated
08/22/2020
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