Provider Demographics
NPI:1477992238
Name:WESTFIELD DENTAL SLEEP MEDICINE PA
Entity Type:Organization
Organization Name:WESTFIELD DENTAL SLEEP MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:FIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-848-2611
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:HECTOR
Mailing Address - State:MN
Mailing Address - Zip Code:55342-0547
Mailing Address - Country:US
Mailing Address - Phone:320-848-2611
Mailing Address - Fax:320-848-2610
Practice Address - Street 1:149 MAIN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:HECTOR
Practice Address - State:MN
Practice Address - Zip Code:55342-0547
Practice Address - Country:US
Practice Address - Phone:320-848-2611
Practice Address - Fax:320-848-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty