Provider Demographics
NPI:1851467658
Name:WESTBROOK, JOHN LEONARD (DDS,)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEONARD
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 1:1422 VT RT 66
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060
Mailing Address - Country:US
Mailing Address - Phone:802-728-9990
Mailing Address - Fax:802-728-3309
Practice Address - Street 1:1422 VT RT 66
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060
Practice Address - Country:US
Practice Address - Phone:802-728-9990
Practice Address - Fax:802-728-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT6131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice