Mark S Weaver, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10751 Issued in TX

Practice address

4638 Westgate Blvd
Austin, TX 78745-1461

Phone

(512) 892-2443

Fax

(512) 892-2002

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Longhorn Pediatric Dentistry and Orthodontics

  • Pediatric Dentistry
  • Austin, TX
  • NPI 1336519313
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124138755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4638 WESTGATE BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787451461",
            "telephone_number": "512-892-2443",
            "fax_number": "512-892-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4638 WESTGATE BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787451461",
            "telephone_number": "512-892-2443",
            "fax_number": "512-892-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "10751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIP",
            "identifier": "B10751",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlotte Ann Weaver, M.D.
• Courtney Lynn Weaver, LCSW
• Garth B Weaver, O.D.
• Jeannette Amie Weaver, PT
• Kinaye' Jade Weaver, NP
• Stephanie Mei Li Weaver, PHARMD
• Terry Harlan Weaver, R.PH.
• Tiffany Carin Weaver, LVN
• Vanessa Weaver, MSN, APRN, AGCNS-BC
• Weavings Wellness Group

• Pediatric Dentistry in Austin, TX
• Providers in Austin, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.