Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 55837 | CA |
NPI | 1013115344 |
---|---|
Provider Name | Dr. Jerad L West |
First Address | Truckee, CA 96161-2125 |
Second Address | Truckee, CA 96161-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2007 |
Last Update Date | 09/07/2007 |