Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 9112 | TN |
NPI | 1033370853 |
---|---|
Provider Name | Elizabeth Flanagan Webb |
First Address | Hixson, TN 37343-3299 |
Second Address | Hixson, TN 37343-3299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 03/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1527928 | (05) | TN |