Provider Demographics
NPI:1790280980
Name:A WESTFALL DENTAL CORPORATION
Entity Type:Organization
Organization Name:A WESTFALL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-600-2835
Mailing Address - Street 1:PO BOX 551167
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96155-1167
Mailing Address - Country:US
Mailing Address - Phone:530-208-8917
Mailing Address - Fax:
Practice Address - Street 1:3358 SANDY WAY
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8105
Practice Address - Country:US
Practice Address - Phone:530-600-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental