Individual
DR. RYAN WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
527 GOTT ROAD, VANCE AFB, OK 73705-5105
(208) 964-5306
Mailing address
527 GOTT ROAD, VANCE AFB, OK 73705-5105
(208) 964-5306
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2017017100
MO
Other
Enumeration date
05/10/2017
Last updated
06/17/2022
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