Healthcare Provider Details

I. General information

NPI: 1174265581
Provider Name (Legal Business Name): WESTPARK PERIODONTICS & IMPLANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 TURNPIKE DR UNIT 208
WESTMINSTER CO
80031-7042
US

IV. Provider business mailing address

8501 TURNPIKE DR UNIT 208
WESTMINSTER CO
80031-7042
US

V. Phone/Fax

Practice location:
  • Phone: 303-424-7757
  • Fax:
Mailing address:
  • Phone: 303-424-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: CHAD HENDRICKS
Title or Position: CREDENTIALING
Credential:
Phone: 612-859-0444