Provider Demographics
NPI:1073613204
Name:WEBSTER, CHADWICK NATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:NATHAN
Last Name:WEBSTER
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 1:8190 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4309
Mailing Address - Country:US
Mailing Address - Phone:918-307-0307
Mailing Address - Fax:918-307-0308
Practice Address - Street 1:8190 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4309
Practice Address - Country:US
Practice Address - Phone:918-307-0307
Practice Address - Fax:918-307-0308
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071070AMedicaid