1477928794 NPI number — WEBB ORTHODONTICS, LLP

Table of content: (NPI 1477928794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477928794 NPI number — WEBB ORTHODONTICS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEBB ORTHODONTICS, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477928794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 W 42ND ST STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSBLUFF
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69361-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-630-0670
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 W 42ND ST STE 1100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-630-0670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
SAMI
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
ORTHODONTIST/PARTNER
Authorized Official Telephone Number:
308-630-0670

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  6281 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100251889-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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