Provider Demographics
NPI:1528196078
Name:WESTCOTT, MICHAEL CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:WESTCOTT
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 1:3111 45TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1974
Mailing Address - Country:US
Mailing Address - Phone:561-687-0006
Mailing Address - Fax:561-687-8611
Practice Address - Street 1:3111 45TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1974
Practice Address - Country:US
Practice Address - Phone:561-687-0006
Practice Address - Fax:561-687-8611
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist