Provider Demographics
NPI:1386833382
Name:KIRK WESTERVELT DMD,PC
Entity type:Organization
Organization Name:KIRK WESTERVELT DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:W
Authorized Official - Last Name:WESTERVELT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:928-204-2062
Mailing Address - Street 1:1146 W HWY 89A STE A
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5760
Mailing Address - Country:US
Mailing Address - Phone:928-204-2062
Mailing Address - Fax:
Practice Address - Street 1:1146 W HWY 89A STE A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5760
Practice Address - Country:US
Practice Address - Phone:928-204-2062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty