Provider Demographics
NPI:1487664645
Name:WESTBERRY, JAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:J
Last Name:WESTBERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 HIDEAWAY FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9286
Mailing Address - Country:US
Mailing Address - Phone:386-423-1441
Mailing Address - Fax:386-423-1957
Practice Address - Street 1:2234 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8304
Practice Address - Country:US
Practice Address - Phone:386-423-1440
Practice Address - Fax:386-423-1957
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice