Provider Demographics
NPI:1265549968
Name:WESTBROOK, MARSTON THORN (DDS)
Entity type:Individual
Prefix:
First Name:MARSTON
Middle Name:THORN
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 1:980 W IRONWOOD DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2668
Mailing Address - Country:US
Mailing Address - Phone:208-664-0844
Mailing Address - Fax:208-664-9682
Practice Address - Street 1:980 W IRONWOOD DR
Practice Address - Street 2:SUITE 301
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2668
Practice Address - Country:US
Practice Address - Phone:208-664-0844
Practice Address - Fax:208-664-9682
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1861-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002067800Medicaid
ID805105200Medicaid