Provider Demographics
NPI:1568686640
Name:BRAD G. WESTFALL, D.D.S.,P.C.
Entity Type:Organization
Organization Name:BRAD G. WESTFALL, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-789-2515
Mailing Address - Street 1:430 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-1640
Mailing Address - Country:US
Mailing Address - Phone:918-789-2515
Mailing Address - Fax:918-789-2516
Practice Address - Street 1:430 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-1640
Practice Address - Country:US
Practice Address - Phone:918-789-2515
Practice Address - Fax:918-789-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty