Organization
WEAVER FAMILY DENTISTY PA
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
4302 13TH AVE S, FARGO, ND 58103-3395
(208) 284-0054
Mailing address
3974 BELL CT, NAMPA, ID 83686-1411
(208) 284-0054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2129
ND
Other
Enumeration date
04/13/2009
Last updated
07/03/2012
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