Provider Demographics
NPI:1427201821
Name:WEBSTER ORTHODONTICS
Entity Type:Organization
Organization Name:WEBSTER ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-236-1912
Mailing Address - Street 1:359 S 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2078
Mailing Address - Country:US
Mailing Address - Phone:859-236-1912
Mailing Address - Fax:859-236-4589
Practice Address - Street 1:359 S 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2078
Practice Address - Country:US
Practice Address - Phone:859-236-1912
Practice Address - Fax:859-236-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41451223X0400X
KY82351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1558490573OtherNPI NUMBER
KY7100016180Medicaid
KY1558559047OtherNPI NUMBER