Provider Demographics
NPI:1023221165
Name:WESTPHAL, REGINALD R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:R
Last Name:WESTPHAL
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:3268 WILD WEST LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-1595
Mailing Address - Country:US
Mailing Address - Phone:719-369-8122
Mailing Address - Fax:970-568-9938
Practice Address - Street 1:8017 FIRST STREET #C
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-1595
Practice Address - Country:US
Practice Address - Phone:970-775-4504
Practice Address - Fax:970-293-8303
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1009881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics