Provider Demographics
NPI:1619561065
Name:WESTMORELAND, BRYCE (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:WESTMORELAND
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 1:233 WES PARK DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4829
Mailing Address - Country:US
Mailing Address - Phone:478-488-3561
Mailing Address - Fax:
Practice Address - Street 1:233 WES PARK DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4829
Practice Address - Country:US
Practice Address - Phone:478-488-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122334122300000X, 1223G0001X
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program