Healthcare Provider Details

I. General information

NPI: 1790396927
Provider Name (Legal Business Name): KYLE MATTHEW WESTBROOK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SAGEBRUSH TRL
ORMOND BEACH FL
32174-8102
US

IV. Provider business mailing address

150 SAGEBRUSH TRL
ORMOND BEACH FL
32174-8102
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-0705
  • Fax: 386-677-9248
Mailing address:
  • Phone: 386-676-0705
  • Fax: 386-677-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN28926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: