Provider Demographics
NPI:1427530161
Name:A WESTFALL DENTAL CORPORATION
Entity type:Organization
Organization Name:A WESTFALL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-600-2835
Mailing Address - Street 1:PO BOX 551167
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96155-1167
Mailing Address - Country:US
Mailing Address - Phone:530-600-2835
Mailing Address - Fax:
Practice Address - Street 1:540 MAIN ST
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9109
Practice Address - Country:US
Practice Address - Phone:530-600-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A WESTFALL DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty