Provider Demographics
NPI:1083684526
Name:WEBB, TERRY DALE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DALE
Last Name:WEBB
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 GRANDE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8991
Mailing Address - Country:US
Mailing Address - Phone:850-696-0820
Mailing Address - Fax:
Practice Address - Street 1:5016 GRANDE DR STE 101
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8991
Practice Address - Country:US
Practice Address - Phone:850-696-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD0006732C1223E0200X
TN68621223E0200X
FLDN278211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics