Healthcare Provider Details

I. General information

NPI: 1902856255
Provider Name (Legal Business Name): MICHAEL WESTREICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MADISON AVE
MADISON NJ
07940-1433
US

IV. Provider business mailing address

18 MADISON AVE
MADISON NJ
07940-1433
US

V. Phone/Fax

Practice location:
  • Phone: 973-822-0330
  • Fax:
Mailing address:
  • Phone: 973-822-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8585
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: