Provider Demographics
NPI:1003468976
Name:A WESTFALL DENTAL CORPORATION
Entity Type:Organization
Organization Name:A WESTFALL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-600-2835
Mailing Address - Street 1:3358 SANDY WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8105
Mailing Address - Country:US
Mailing Address - Phone:530-208-8917
Mailing Address - Fax:
Practice Address - Street 1:2074 LAKE TAHOE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6408
Practice Address - Country:US
Practice Address - Phone:530-600-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A WESTFALL DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental