Provider Demographics
NPI:1437647831
Name:SOUTHPOINTE FAMILY DENTISTRY PLLC DBA WESTMOORE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SOUTHPOINTE FAMILY DENTISTRY PLLC DBA WESTMOORE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MACK
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-844-6333
Mailing Address - Street 1:12208 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5914
Mailing Address - Country:US
Mailing Address - Phone:405-692-5551
Mailing Address - Fax:405-692-5558
Practice Address - Street 1:12208 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5914
Practice Address - Country:US
Practice Address - Phone:405-692-5551
Practice Address - Fax:844-255-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental