Provider Demographics
NPI:1124142377
Name:WESTER, KEITH E (DDS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:E
Last Name:WESTER
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 1:8191 MOORS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-7416
Mailing Address - Country:US
Mailing Address - Phone:269-327-1119
Mailing Address - Fax:269-327-5725
Practice Address - Street 1:8191 MOORS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-7416
Practice Address - Country:US
Practice Address - Phone:269-327-1119
Practice Address - Fax:269-327-5725
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID153681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI666305OtherUNITED CONCORDIA
MID15368OtherBLUE CROSS BLUE SHIELD