Healthcare Provider Details

I. General information

NPI: 1538365960
Provider Name (Legal Business Name): VANESSA L. WEST DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 N MOORPARK RD SUITE B
THOUSAND OAKS CA
91360-4568
US

IV. Provider business mailing address

2955 N MOORPARK RD SUITE B
THOUSAND OAKS CA
91360-4568
US

V. Phone/Fax

Practice location:
  • Phone: 805-492-5050
  • Fax: 805-436-1217
Mailing address:
  • Phone: 805-492-5050
  • Fax: 805-436-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2299
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: