Provider Demographics
NPI:1265500839
Name:WEBBER, SPURGEON WILLARD III (DDS)
Entity type:Individual
Prefix:DR
First Name:SPURGEON
Middle Name:WILLARD
Last Name:WEBBER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:518 EAST BLVD
Mailing Address - Street 2:WEBBER DENTAL BUILDING
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:WEBBER DENTAL BUILDING
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890145BMedicaid