Provider Demographics
NPI:1821318890
Name:WEBB, BRIAN JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFREY
Last Name:WEBB
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 1:10407 DAYTON PIKE
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-5213
Mailing Address - Country:US
Mailing Address - Phone:423-442-5463
Mailing Address - Fax:
Practice Address - Street 1:10407 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-5213
Practice Address - Country:US
Practice Address - Phone:423-442-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR37601223X0400X
TN91151223X0400X
LA59481223X0400X
GADN0145091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533334Medicaid
AR183644608Medicaid