Provider Demographics
NPI:1699386706
Name:WESTGATE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WESTGATE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-980-4800
Mailing Address - Street 1:2323 S WADSWORTH BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3254
Mailing Address - Country:US
Mailing Address - Phone:303-980-4800
Mailing Address - Fax:
Practice Address - Street 1:2323 S WADSWORTH BLVD STE 109
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3254
Practice Address - Country:US
Practice Address - Phone:303-980-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty