Provider Demographics
NPI:1215190939
Name:WEBB, SIRIPORN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIRIPORN
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 ALBEMARLE RD
Mailing Address - Street 2:SUITES B&C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-3800
Mailing Address - Country:US
Mailing Address - Phone:704-910-4720
Mailing Address - Fax:
Practice Address - Street 1:6404 ALBEMARLE RD
Practice Address - Street 2:SUITES B&C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-3800
Practice Address - Country:US
Practice Address - Phone:704-910-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219621223G0001X
NC99201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice