Individual
DR. JOHN S WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3641 ENSIGN RD NE STE 6A, OLYMPIA, WA 98506-5046
(360) 915-6321
(360) 489-1748
Mailing address
3641 ENSIGN RD NE STE 6A, OLYMPIA, WA 98506-5046
(360) 915-6321
(360) 489-1748
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00005111
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000843827
UNITED CONCORDIA PROVIDER
WA
01
—
0035126
L & I PROVIDER NUMBER
WA
05
—
5550603
—
WA
Enumeration date
11/29/2006
Last updated
08/31/2015
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