Active NPI
Gregory C. Weeder, D.D.S.
- Pediatric Dentistry
- La Vista, NE
National Provider Identifier
1346453016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6322
- Practice address
- 9825 Giles Rd # Ab
La Vista, NE 68128-2927 - Phone
- (402) 932-1177
- NPI assigned
- May 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 6322 | NE | Primary |
Addresses
Primary practice location
9825 Giles Rd # Ab
La Vista, NE 68128-2927
Mailing address
9825 Giles Rd # Ab
La Vista, NE 68128-2927
Phone (402) 932-1177
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7810 | Other | NE | BCBS IDENTIFIER |
| 83034611500 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6322 | NE | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Weeder Pediatric Dentistry, PC | Pediatric Dentistry | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- La Vista, NE
- NPI 1962233502
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371168000000",
"number": "1346453016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9825 GILES RD # AB",
"city": "LA VISTA",
"state": "NE",
"postal_code": "681282927",
"telephone_number": "402-932-1177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9825 GILES RD # AB",
"city": "LA VISTA",
"state": "NE",
"postal_code": "681282927",
"telephone_number": "402-932-1177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEEDER",
"first_name": "GREGORY",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2013-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NE",
"license": "6322",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS IDENTIFIER",
"identifier": "7810",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "83034611500",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Vista, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.