Provider Demographics
NPI:1245306133
Name:WESTPHAL, GERALD ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ARTHUR
Last Name:WESTPHAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DEMPSTER STREET
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1172
Mailing Address - Country:US
Mailing Address - Phone:847-824-2786
Mailing Address - Fax:
Practice Address - Street 1:1600 DEMPSTER STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1172
Practice Address - Country:US
Practice Address - Phone:847-824-2786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A12594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist