Provider Demographics
NPI:1437473683
Name:WESTPHAL, ANDREA MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:RAGSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1074 BELL HILL PL
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9035
Mailing Address - Country:US
Mailing Address - Phone:253-227-0154
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60015277124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist