Healthcare Provider Details

I. General information

NPI: 1790611309
Provider Name (Legal Business Name): ANDREW L WEBB DDM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREVCO PLZ STE 104
LAKE SAINT LOUIS MO
63367-1392
US

IV. Provider business mailing address

100 BREVCO PLZ STE 104
LAKE SAINT LOUIS MO
63367-1392
US

V. Phone/Fax

Practice location:
  • Phone: 636-212-9197
  • Fax:
Mailing address:
  • Phone: 636-212-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026026196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: