Adam B Weaver, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2023015375 Issued in MO

Practice address

504 W. Broadway
Ava, MO 65608

Phone

(417) 683-5739

NPI assigned

Aug 11, 2010

Last updated

Jul 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: adam.weaver.p1@direct.jordanvalley.nextgenshare.com
• Direct secure messaging: adam.weaver.p1@direct.kch.nextgenshare.com

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1669787974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1359",
            "city": "AVA",
            "state": "MO",
            "postal_code": "656081359",
            "telephone_number": "417-683-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W. BROADWAY",
            "city": "AVA",
            "state": "MO",
            "postal_code": "65608",
            "telephone_number": "417-683-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "ADAM",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-11",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2023015375",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "1351",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deann Lois Thompson
• Kristen Rose Toone, PHARMD
• VNP Contracts LLC (Elevated Healthcare Clinic)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0056)
• Walgreen Co (Ava Drug #15726, Powered by Walgreens)
• Shelby Lynn Yake, MSED, CHW-C, TTS

• Dentist in Ava, MO
• Providers in Ava, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.