Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN009212 | GA |
NPI | 1366435117 |
---|---|
Provider Name | Dr. Richard Lee Weber JR. |
First Address | Gainesville, GA 30501-2223 |
Second Address | Clayton, GA 30525-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 31/07/2007 |