1497711089 NPI number — NADIA MARADIAGA WEBER DDS

Table of content: MICHAEL H LAZZARI (NPI 1750865135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497711089 NPI number — NADIA MARADIAGA WEBER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBER
Provider First Name:
NADIA
Provider Middle Name:
MARADIAGA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARADIAGA
Provider Other First Name:
NADIA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497711089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANNON FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-263-3965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 4TH STREET SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANNON FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-263-3965
Provider Business Practice Location Address Fax Number:
651-457-8574
Provider Enumeration Date:
04/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D12169 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: D12169 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)