Provider Demographics
NPI:1235242330
Name:WEBB, CARLA DAWN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:DAWN
Last Name:WEBB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6159
Mailing Address - Country:US
Mailing Address - Phone:407-499-8135
Mailing Address - Fax:
Practice Address - Street 1:3801 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6159
Practice Address - Country:US
Practice Address - Phone:407-499-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3187-01122300000X
MSENDO-368-031223E0200X
FLDN219181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018596700Medicaid