Healthcare Provider Details

I. General information

NPI: 1306930276
Provider Name (Legal Business Name): WESTOWN DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 INDIAN WOOD CIR
MAUMEE OH
43537-4410
US

IV. Provider business mailing address

3210 BRIARFIELD BLVD
MAUMEE OH
43537-9501
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-2400
  • Fax: 419-866-5320
Mailing address:
  • Phone: 419-866-2400
  • Fax: 419-866-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5830
License Number StateWI

VIII. Authorized Official

Name: DR. HISHAM KALOTI
Title or Position: DENTIST,OWNER
Credential: DDS
Phone: 419-866-2400