Provider Demographics
NPI:1578817490
Name:WEBSTER, NEAL P (DDS)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:P
Last Name:WEBSTER
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 1:3611 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6209
Mailing Address - Country:US
Mailing Address - Phone:208-459-3666
Mailing Address - Fax:208-455-5058
Practice Address - Street 1:3611 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6209
Practice Address - Country:US
Practice Address - Phone:208-459-3666
Practice Address - Fax:208-455-5058
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-35601223X0400X
ORD79801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1487789681OtherTYPE 2 NPI NUMBER