Provider Demographics
NPI:1821261306
Name:WEBBER, RAYMOND T (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:T
Last Name:WEBBER
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 1:610 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2516
Mailing Address - Country:US
Mailing Address - Phone:529-352-0055
Mailing Address - Fax:352-529-2022
Practice Address - Street 1:610 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696
Practice Address - Country:US
Practice Address - Phone:352-529-0055
Practice Address - Fax:352-529-2022
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00090171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics