Provider Demographics
NPI:1760904536
Name:WESTERBERG, AMY LURAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LURAE
Last Name:WESTERBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LURAE
Other - Last Name:TARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4546 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1816
Mailing Address - Country:US
Mailing Address - Phone:816-931-2342
Mailing Address - Fax:
Practice Address - Street 1:4546 MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1816
Practice Address - Country:US
Practice Address - Phone:816-931-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170231841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice