Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Weaver, DDS

Individual provider Dentist · NPI 1578884235

Kelly Weaver, DDS is a Dentist in Blackfoot, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2010
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

310 W Idaho St
Blackfoot, ID 83221-1710
Phone: (208) 785-2255
Fax: (208) 785-2275
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D4298 (ID)

Record details

NPI number1578884235
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedJune 17, 2010
Last updated in NPPESMarch 8, 2024
Certification dateMarch 8, 2024
Mailing addressPo Box 248, Blackfoot, ID 83221-0248

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