Provider Demographics
NPI:1932262607
Name:WESTVIEW FAMILY DENTAL CARE, PLLC
Entity Type:Organization
Organization Name:WESTVIEW FAMILY DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:JAKOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-772-9600
Mailing Address - Street 1:4130 N 108TH AVE
Mailing Address - Street 2:SUITE 103-104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5774
Mailing Address - Country:US
Mailing Address - Phone:623-772-9600
Mailing Address - Fax:623-772-9601
Practice Address - Street 1:4130 N 108TH AVE
Practice Address - Street 2:SUITE 103-104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5774
Practice Address - Country:US
Practice Address - Phone:623-772-9600
Practice Address - Fax:623-772-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty