Healthcare Provider Details

I. General information

NPI: 1669306569
Provider Name (Legal Business Name): PHILIP PETER WEBB II
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 SCRANTON CARBONDALE HWY
EYNON PA
18403-1004
US

IV. Provider business mailing address

696 SCRANTON CARBONDALE HWY
EYNON PA
18403-1004
US

V. Phone/Fax

Practice location:
  • Phone: 570-876-4488
  • Fax:
Mailing address:
  • Phone: 570-876-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045740
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: