Healthcare Provider Details

I. General information

NPI: 1972739118
Provider Name (Legal Business Name): BRACKEN M WEBB DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 CINCINNATI COLUMBUS RD
WEST CHESTER OH
45069-4178
US

IV. Provider business mailing address

9215 CINCINNATI COLUMBUS RD
WEST CHESTER OH
45069-4178
US

V. Phone/Fax

Practice location:
  • Phone: 513-777-2313
  • Fax: 513-777-5942
Mailing address:
  • Phone: 513-777-2313
  • Fax: 513-777-5942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023387
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number27906
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.023387
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: