Provider Demographics
NPI:1689778052
Name:WESTFALL, JACQUELINE S (DDS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 SCIENCE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48064
Mailing Address - Country:US
Mailing Address - Phone:517-381-0405
Mailing Address - Fax:
Practice Address - Street 1:2277 SCIENCE PARKWAY
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48064
Practice Address - Country:US
Practice Address - Phone:517-381-0405
Practice Address - Fax:517-349-4416
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice