Provider Demographics
NPI:1386869923
Name:WEBB, EDWIN G (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:G
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 WELLS BRANCH PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6903
Mailing Address - Country:US
Mailing Address - Phone:512-251-1274
Mailing Address - Fax:
Practice Address - Street 1:2013 WELLS BRANCH PKWY STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6903
Practice Address - Country:US
Practice Address - Phone:512-251-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13961OtherLICENSE NUMBER