Provider Demographics
NPI:1972739118
Name:WEBB, BRACKEN M (DDS)
Entity Type:Individual
Prefix:
First Name:BRACKEN
Middle Name:M
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 1:9215 CINCINNATI COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4178
Mailing Address - Country:US
Mailing Address - Phone:513-777-2313
Mailing Address - Fax:513-777-5942
Practice Address - Street 1:9215 CINCINNATI COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4178
Practice Address - Country:US
Practice Address - Phone:513-777-2313
Practice Address - Fax:513-777-5942
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279061223P0221X
OH30.0233871223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentistGroup - Single Specialty