Provider Demographics
NPI:1467550160
Name:WEBSTER, MARK J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N MAIN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2623
Mailing Address - Country:US
Mailing Address - Phone:435-867-9172
Mailing Address - Fax:435-867-0997
Practice Address - Street 1:415 N MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2623
Practice Address - Country:US
Practice Address - Phone:435-867-9172
Practice Address - Fax:435-867-0997
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371297-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics