Individual
MARK S WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4638 WESTGATE BLVD, AUSTIN, TX 78745-1461
(512) 892-2443
(512) 892-2002
Mailing address
4638 WESTGATE BLVD, AUSTIN, TX 78745-1461
(512) 892-2443
(512) 892-2002
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10751
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B10751
CHIP
TX
Enumeration date
08/30/2006
Last updated
07/08/2007
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