Provider Demographics
NPI:1972851921
Name:MICHAEL D. WEBB, DDS, PC
Entity Type:Organization
Organization Name:MICHAEL D. WEBB, DDS, PC
Other - Org Name:THE CENTER FOR PEDIATRIC DENTISTRY AND SEDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-562-2667
Mailing Address - Street 1:10409 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4407
Mailing Address - Country:US
Mailing Address - Phone:804-562-2667
Mailing Address - Fax:804-562-2698
Practice Address - Street 1:10409 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4407
Practice Address - Country:US
Practice Address - Phone:804-562-2667
Practice Address - Fax:804-562-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9177050Medicaid
VA010067669Medicaid