Provider Demographics
NPI:1548051055
Name:WEAVER, GRANT E (DDS)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:E
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2637
Mailing Address - Country:US
Mailing Address - Phone:614-267-5413
Mailing Address - Fax:614-267-2171
Practice Address - Street 1:4501 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2637
Practice Address - Country:US
Practice Address - Phone:614-267-5413
Practice Address - Fax:614-267-2171
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0279291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice