Provider Demographics
NPI:1316040884
Name:WESTERMAN, GARY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:WESTERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 MAIN ST NORTH
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1252
Mailing Address - Country:US
Mailing Address - Phone:203-264-5630
Mailing Address - Fax:203-264-7873
Practice Address - Street 1:1063 MAIN ST NORTH
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1252
Practice Address - Country:US
Practice Address - Phone:203-264-5630
Practice Address - Fax:203-264-7873
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist