Provider Demographics
NPI:1366532798
Name:WESTBROOK, WAYNE D (DDS)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DUTTON
Mailing Address - State:MI
Mailing Address - Zip Code:49316
Mailing Address - Country:US
Mailing Address - Phone:616-698-6000
Mailing Address - Fax:616-554-3260
Practice Address - Street 1:3125 68TH ST SE
Practice Address - Street 2:
Practice Address - City:DUTTON
Practice Address - State:MI
Practice Address - Zip Code:49316
Practice Address - Country:US
Practice Address - Phone:616-698-6000
Practice Address - Fax:616-554-3260
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI125670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist