Healthcare Provider Details

I. General information

NPI: 1760810709
Provider Name (Legal Business Name): BRIAN WEST D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 21ST AVE S
NASHVILLE TN
37212-4314
US

IV. Provider business mailing address

2000 21ST AVE S
NASHVILLE TN
37212-4314
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-3334
  • Fax: 615-385-3335
Mailing address:
  • Phone: 615-385-3334
  • Fax: 615-385-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7163
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: