Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 6862 | TN |
Y | 1223E0200X | Endodontist | D0006732C | AL |
NPI | 1083684526 |
---|---|
Provider Name | Dr. Terry Dale Webb |
First Address | Virginia Beach, VA 23456-6313 |
Second Address | Norfolk, VA 23511-2896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 15/04/2020 |