Provider Demographics
NPI:1235374786
Name:WESTWOOD DENTAL GROUP
Entity Type:Organization
Organization Name:WESTWOOD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUSSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-722-8400
Mailing Address - Street 1:1458 CAMPBELL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4669
Mailing Address - Country:US
Mailing Address - Phone:713-722-8400
Mailing Address - Fax:713-722-8441
Practice Address - Street 1:14039 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5360
Practice Address - Country:US
Practice Address - Phone:281-558-3384
Practice Address - Fax:713-722-8441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009830301Medicaid
CAG60189-04OtherSTATE GOVERNMENT PROGRAM TEXAS CHIP