Healthcare Provider Details

I. General information

NPI: 1447195110
Provider Name (Legal Business Name): WEST BAY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 TOWN CENTER BLVD UNIT 102
PANAMA CITY BEACH FL
32413-9668
US

IV. Provider business mailing address

8411 TOWN CENTER BLVD UNIT 102
PANAMA CITY BEACH FL
32413-9668
US

V. Phone/Fax

Practice location:
  • Phone: 850-804-1177
  • Fax: 850-804-1218
Mailing address:
  • Phone: 850-804-1177
  • Fax: 850-804-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. COLLIN MYRICK
Title or Position: OWNER
Credential:
Phone: 850-428-0901