Provider Demographics
NPI:1952572034
Name:WEBB, MICHAEL TRENT
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TRENT
Last Name:WEBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 GRAND JCT
Mailing Address - Street 2:SUITE G
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7974
Mailing Address - Country:US
Mailing Address - Phone:601-450-2540
Mailing Address - Fax:
Practice Address - Street 1:69 GRAND JCT
Practice Address - Street 2:SUITE G
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7974
Practice Address - Country:US
Practice Address - Phone:601-450-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3424-071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice