Provider Demographics
NPI:1356445928
Name:WEBSTER DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:WEBSTER DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-280-8111
Mailing Address - Street 1:17240 MILL FOREST LN
Mailing Address - Street 2:STE B
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4366
Mailing Address - Country:US
Mailing Address - Phone:281-280-8111
Mailing Address - Fax:281-280-8525
Practice Address - Street 1:17240 MILL FOREST LN
Practice Address - Street 2:STE B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4366
Practice Address - Country:US
Practice Address - Phone:281-280-8111
Practice Address - Fax:281-280-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84D541OtherBCBS
121808OtherUNITED CONCORDIA
TXTX0D15730OtherBCBS