Healthcare Provider Details

I. General information

NPI: 1437294873
Provider Name (Legal Business Name): RONALD STEWART WESTERVELT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S SAGINAW ST
SAINT CHARLES MI
48655-1429
US

IV. Provider business mailing address

228 S SAGINAW ST P O BOX 129
SAINT CHARLES MI
48655-1429
US

V. Phone/Fax

Practice location:
  • Phone: 989-865-6731
  • Fax: 989-865-6141
Mailing address:
  • Phone: 989-865-6731
  • Fax: 989-865-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10753
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: