Provider Demographics
NPI:1316953516
Name:WEBB, BRENDEN M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENDEN
Middle Name:M
Last Name:WEBB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 HOLSTON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2131
Mailing Address - Country:US
Mailing Address - Phone:423-968-5112
Mailing Address - Fax:423-968-5687
Practice Address - Street 1:523 HOLSTON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2131
Practice Address - Country:US
Practice Address - Phone:423-968-5112
Practice Address - Fax:423-968-5687
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-80421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice