Provider Demographics
NPI:1114341633
Name:MA WEBB DDS MS PA &CM WEBB DDS MS MBA PLLC
Entity Type:Organization
Organization Name:MA WEBB DDS MS PA &CM WEBB DDS MS MBA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-364-7343
Mailing Address - Street 1:2915 COLTSGATE RD
Mailing Address - Street 2:102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3882
Mailing Address - Country:US
Mailing Address - Phone:704-364-7343
Mailing Address - Fax:704-364-2729
Practice Address - Street 1:2915 COLTSGATE RD
Practice Address - Street 2:102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3882
Practice Address - Country:US
Practice Address - Phone:704-364-7343
Practice Address - Fax:704-364-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty