Provider Demographics
NPI:1336232453
Name:WESTERMAN, GARY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:H
Last Name:WESTERMAN
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 1:2410 SO 73RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2395
Mailing Address - Country:US
Mailing Address - Phone:402-397-3377
Mailing Address - Fax:402-343-1039
Practice Address - Street 1:2410 SO 73RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2395
Practice Address - Country:US
Practice Address - Phone:402-397-3377
Practice Address - Fax:402-343-1039
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE37911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081513000Medicaid