Healthcare Provider Details

I. General information

NPI: 1033370853
Provider Name (Legal Business Name): ELIZABETH FLANAGAN WEBB D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 HIXSON PIKE STE A
HIXSON TN
37343-3299
US

IV. Provider business mailing address

5470 HIXSON PIKE STE A
HIXSON TN
37343-3299
US

V. Phone/Fax

Practice location:
  • Phone: 423-842-0165
  • Fax: 423-842-7614
Mailing address:
  • Phone: 423-842-0165
  • Fax: 423-842-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9112
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1527928
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: