Provider Demographics
NPI:1255359469
Name:WEBB, DAVID EVANS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EVANS
Last Name:WEBB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1590 WEBSTER ST STE F
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4932
Mailing Address - Country:US
Mailing Address - Phone:210-627-1444
Mailing Address - Fax:
Practice Address - Street 1:1590 WEBSTER ST STE F
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4932
Practice Address - Country:US
Practice Address - Phone:210-627-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229101223S0112X
CA64254204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery