Provider Demographics
NPI:1902815509
Name:WESTBERRY, RICHARD S (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:WESTBERRY
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 1:3120 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3548
Mailing Address - Country:US
Mailing Address - Phone:386-761-8822
Mailing Address - Fax:
Practice Address - Street 1:3120 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3548
Practice Address - Country:US
Practice Address - Phone:386-761-8822
Practice Address - Fax:386-761-8842
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9504OtherSTATE LICENSE