Provider Demographics
NPI:1619714201
Name:WEBSTER, ALEXANDER BRIAN
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:BRIAN
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 BROOKMONT PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4801
Mailing Address - Country:US
Mailing Address - Phone:704-689-6241
Mailing Address - Fax:
Practice Address - Street 1:500 28TH AVE N STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4298
Practice Address - Country:US
Practice Address - Phone:615-329-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice