Provider Demographics
NPI:1679538482
Name:WEST, J. DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:DANIEL
Last Name:WEST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 N. 121 BYPASS
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071
Mailing Address - Country:US
Mailing Address - Phone:270-759-4242
Mailing Address - Fax:270-759-4747
Practice Address - Street 1:1711 N. 121 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-759-4242
Practice Address - Fax:270-759-4747
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6963122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health