Healthcare Provider Details

I. General information

NPI: 1689680365
Provider Name (Legal Business Name): MARK A. WESTHOFF,D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 W CENTENNIAL AVE
CARTHAGE MO
64836-2846
US

IV. Provider business mailing address

626 W CENTENNIAL AVE
CARTHAGE MO
64836-2846
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-9006
  • Fax: 417-358-3064
Mailing address:
  • Phone: 417-358-9006
  • Fax: 417-358-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberMO14349
License Number StateMO

VIII. Authorized Official

Name: DR. MARK ALAN WESTHOFF
Title or Position: PRESIDENT/CEO
Credential: D.D.S.
Phone: 417-358-9006