# BROOKVILLE DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891719480
- **Authorized official:** WILLIAM J WEAVER D.M.D. (PRESIDENT)
- **Authorized official phone:** (814) 849-2652

## Contact information

- **Practice address:** 123 MAIN ST, BROOKVILLE, PA 15825-1212
- **Practice address phone:** (814) 849-2652
- **Mailing address:** 123 MAIN ST, BROOKVILLE, PA 15825-1212
- **Mailing address phone:** (814) 849-2652

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS024744L | PA | Yes |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0018235500001 | — | PA |