Provider Demographics
NPI:1326774878
Name:WESTHORPE, JACOB ROSS (DMD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ROSS
Last Name:WESTHORPE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 VENUS WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3020
Mailing Address - Country:US
Mailing Address - Phone:925-783-0158
Mailing Address - Fax:
Practice Address - Street 1:1201 INDUSTRIAL ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0757
Practice Address - Country:US
Practice Address - Phone:530-241-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist