Provider Demographics
NPI:1205934031
Name:WESTENBURG, CRISTINA - (DDS)
Entity type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:-
Last Name:WESTENBURG
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 1:3285 WISSING LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9287
Mailing Address - Country:US
Mailing Address - Phone:734-678-6526
Mailing Address - Fax:269-983-5663
Practice Address - Street 1:2460 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1874
Practice Address - Country:US
Practice Address - Phone:269-983-5583
Practice Address - Fax:269-983-5663
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010183261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice