Provider Demographics
NPI:1407172570
Name:WESTGATE DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:WESTGATE DENTAL GROUP PLLC
Other - Org Name:WESTGATE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-248-1221
Mailing Address - Street 1:17480 DALLAS PKWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7337
Mailing Address - Country:US
Mailing Address - Phone:972-248-1221
Mailing Address - Fax:972-248-1072
Practice Address - Street 1:520 W BROWN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5815
Practice Address - Country:US
Practice Address - Phone:972-248-1221
Practice Address - Fax:972-248-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty