Provider Demographics
NPI:1811022692
Name:WESTBROOK, THOMAS E JR (DR)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:WESTBROOK
Suffix:JR
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HUTSON ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2415
Mailing Address - Country:US
Mailing Address - Phone:870-762-5274
Mailing Address - Fax:870-762-5280
Practice Address - Street 1:507 HUTSON ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2415
Practice Address - Country:US
Practice Address - Phone:870-762-5274
Practice Address - Fax:870-762-5280
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR24151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice