Provider Demographics
NPI:1669548939
Name:WESTFALL, JOHN C (DDS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:WESTFALL
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-0700
Mailing Address - Country:US
Mailing Address - Phone:304-462-7343
Mailing Address - Fax:304-462-7336
Practice Address - Street 1:809 MINERAL RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-0700
Practice Address - Country:US
Practice Address - Phone:304-462-7343
Practice Address - Fax:304-462-7336
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2138OtherDENTAL LISC
WV0136125000Medicaid