Provider Demographics
NPI:1124053301
Name:WUESTHOFF, THOMAS F (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:WUESTHOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 AUBURN CT
Mailing Address - Street 2:#5
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3614
Mailing Address - Country:US
Mailing Address - Phone:805-496-4247
Mailing Address - Fax:805-496-9830
Practice Address - Street 1:250 N SEE VEE LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8130
Practice Address - Country:US
Practice Address - Phone:760-873-3443
Practice Address - Fax:760-503-0205
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP11576FMedicaid