Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 63299 | CA |
Y | 1223D0004X | Dentist Anesthesiologist | GA 1763 | CA |
NPI | 1578975587 |
---|---|
Provider Name | Dr. David Westerhaus |
First Address | Sacramento, CA 95829-9298 |
Second Address | Sacramento, CA 95829-9298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2014 |
Last Update Date | 25/08/2015 |