Provider Demographics
NPI:1992967079
Name:WEBB, AUSTIN GARDNER (DMD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:GARDNER
Last Name:WEBB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 SELWYN AVE UNIT 216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1779
Mailing Address - Country:US
Mailing Address - Phone:352-339-4911
Mailing Address - Fax:
Practice Address - Street 1:805 W WARREN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5023
Practice Address - Country:US
Practice Address - Phone:704-484-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN184411223G0001X
NC104461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice