Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 100988 | CO |
NPI | 1023221165 |
---|---|
Provider Name | Dr. Reginald R. Westphal |
First Address | Wellington, CO 80549-1595 |
Second Address | Wellington, CO 80549-1595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 11/06/2019 |