Provider Demographics
NPI: | 1699131946 |
---|---|
Name: | KATHERINE A HART WESTPHAL, PLLC |
Entity type: | Organization |
Organization Name: | KATHERINE A HART WESTPHAL, PLLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KATHERINE |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | HART WESTPHAL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS, MDS |
Authorized Official - Phone: | 901-569-9431 |
Mailing Address - Street 1: | 1849 MEMORIAL BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | MURFREESBORO |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37129-1522 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-890-7246 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1849 MEMORIAL BLVD |
Practice Address - Street 2: | |
Practice Address - City: | MURFREESBORO |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37129-1522 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-890-7246 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-01-01 |
Last Update Date: | 2016-01-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 9017 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |