Provider Demographics
NPI:1902892672
Name:WEBER, CAROL DIENER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:DIENER
Last Name:WEBER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:JOAN
Other - Last Name:DIENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:480 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:808-473-0495
Mailing Address - Fax:808-473-2847
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-473-0495
Practice Address - Fax:808-473-2847
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 139071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics