Provider Demographics
NPI:1962219600
Name:VON WESTERNHAGEN DENTAL CORPORATION
Entity type:Organization
Organization Name:VON WESTERNHAGEN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-274-4529
Mailing Address - Street 1:1414 W EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1414 W EDINGER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4307
Practice Address - Country:US
Practice Address - Phone:312-274-4529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty