Provider Demographics
NPI:1386270692
Name:WESTBROOKS, YESHA BANAJI (DDS)
Entity type:Individual
Prefix:
First Name:YESHA
Middle Name:BANAJI
Last Name:WESTBROOKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YESHA
Other - Middle Name:
Other - Last Name:BANAJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:521 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-9503
Mailing Address - Country:US
Mailing Address - Phone:606-425-5769
Mailing Address - Fax:
Practice Address - Street 1:521 CRANE RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-9503
Practice Address - Country:US
Practice Address - Phone:606-425-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104841223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100693960Medicaid