Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 55703 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 19775 | MA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 22087 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A81216 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | M0604 | TX |
NPI | 1174592372 |
---|---|
Provider Name | Dr. Trent Howard Westernoff |
First Address | Laguna Niguel, CA 92677 |
Second Address | Laguna Niguel, CA 92677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 21/11/2007 |