Provider Demographics
NPI:1780096438
Name:BRACKEN WEBB, D.D.S., LLC
Entity type:Organization
Organization Name:BRACKEN WEBB, D.D.S., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRACKEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-592-9737
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:513-779-5942
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:513-779-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023387261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental