Provider Demographics
NPI:1922195395
Name:WEBER, TIMOTHY M (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:WEBER
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:M
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD MD
Mailing Address - Street 1:222 S WOODS MILL RD STE 720
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-434-0493
Mailing Address - Fax:314-434-7883
Practice Address - Street 1:222 S WOODSMILL ROAD
Practice Address - Street 2:SUITE 720 NORTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-434-0493
Practice Address - Fax:314-434-7883
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15589204E00000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000387Medicare ID - Type Unspecified
E44194Medicare UPIN