Organization
AWL DENTISTRY PC
Active
Other names
Advantage Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES R WEAVER DDS (PRESIDENT)
(208) 284-0054
Entity
Organization
Contact information
Practice address
170 S CREASY LN STE 1730, LAFAYETTE, IN 47905-0759
(765) 913-9070
Mailing address
3974 BELL CT, NAMPA, ID 83686-1411
(208) 284-0054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011732A
IN
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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