Healthcare Provider Details

I. General information

NPI: 1598144727
Provider Name (Legal Business Name): KYLE WESTHAFER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 EAST MARKET ST
AKRON OH
44309
US

IV. Provider business mailing address

1205 KARLA DR
CLINTON OH
44216-9699
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3783
  • Fax:
Mailing address:
  • Phone: 330-714-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.024490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: