Provider Demographics
NPI:1467670349
Name:WESTMORELAND, DARYL MARSHALL SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:MARSHALL
Last Name:WESTMORELAND
Suffix:SR
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:PO BOX 432
Mailing Address - Street 2:PO BOX 432
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-0432
Mailing Address - Country:US
Mailing Address - Phone:985-229-2192
Mailing Address - Fax:
Practice Address - Street 1:68144 HIGHWAY 51
Practice Address - Street 2:68144 HIGHWAY 51
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-0432
Practice Address - Country:US
Practice Address - Phone:985-229-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1834815Medicaid