Provider Demographics
NPI:1912179706
Name:S. W. WEBBER, III, DDS, PA
Entity Type:Organization
Organization Name:S. W. WEBBER, III, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPURGEON
Authorized Official - Middle Name:WILLARD
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-332-5848
Mailing Address - Street 1:518 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5110
Mailing Address - Country:US
Mailing Address - Phone:704-332-5848
Mailing Address - Fax:704-332-5817
Practice Address - Street 1:518 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5110
Practice Address - Country:US
Practice Address - Phone:704-332-5848
Practice Address - Fax:704-332-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890145BMedicaid