Provider Demographics
NPI:1427015080
Name:WEBBER, BENJAMIN LUKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LUKE
Last Name:WEBBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2287 RALEIGH CT, SUITE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-553-8484
Mailing Address - Fax:888-235-6922
Practice Address - Street 1:2287 RALEIGH CT, SUITE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-553-8484
Practice Address - Fax:888-235-6922
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82191223E0200X
NY053483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist