Brian Dean Westfall, DDS

Individual provider Active NPI General Practice Dentistry · Lorena, TX

NPI 1831204205 · NPPES record last updated Aug 8, 2012

Key facts

NPI
1831204205
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
19417 (TX)
Practice address
605 Gibraltar LN
Lorena, TX 76655-4060
Phone
(254) 857-3702
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
19417TXMDGeneral Practice Dentistry
5515OKMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19417 TX Yes

Addresses

Primary practice location

605 Gibraltar LN
Lorena, TX 76655-4060

Mailing address

605 Gibraltar LN
Lorena, TX 76655-4060
Phone (254) 857-3702

Other identifiers

IdentifierTypeStateIssuer
092957202MedicaidTX

Other providers in Lorena, TX

All providers in Lorena, TX · General Practice Dentistry in Texas

Sources for this page

Verify at the official NPI Registry.