Provider Demographics
NPI:1689680365
Name:MARK A. WESTHOFF,D.D.S.,P.C.
Entity Type:Organization
Organization Name:MARK A. WESTHOFF,D.D.S.,P.C.
Other - Org Name:MARK A. WESTHOFF,D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WESTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-358-9006
Mailing Address - Street 1:626 W CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2846
Mailing Address - Country:US
Mailing Address - Phone:417-358-9006
Mailing Address - Fax:417-358-3064
Practice Address - Street 1:626 W CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2846
Practice Address - Country:US
Practice Address - Phone:417-358-9006
Practice Address - Fax:417-358-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO14349261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental