Provider Demographics
NPI:1669993812
Name:WEBB ORTHODONTICS
Entity type:Organization
Organization Name:WEBB ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:GARDNER
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-339-4911
Mailing Address - Street 1:805 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5023
Mailing Address - Country:US
Mailing Address - Phone:704-484-1633
Mailing Address - Fax:704-484-1632
Practice Address - Street 1:805 W WARREN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5023
Practice Address - Country:US
Practice Address - Phone:704-484-1633
Practice Address - Fax:704-484-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1992967079Medicaid