Provider Demographics
NPI:1437294873
Name:WESTERVELT, RONALD STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STEWART
Last Name:WESTERVELT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 S SAGINAW ST
Mailing Address - Street 2:P O BOX 129
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MI
Mailing Address - Zip Code:48655-1429
Mailing Address - Country:US
Mailing Address - Phone:989-865-6731
Mailing Address - Fax:989-865-6141
Practice Address - Street 1:228 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MI
Practice Address - Zip Code:48655-1429
Practice Address - Country:US
Practice Address - Phone:989-865-6731
Practice Address - Fax:989-865-6141
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI107531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4066092Medicaid