Healthcare Provider Details

I. General information

NPI: 1952733420
Provider Name (Legal Business Name): WESTOVER AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18807 SE MCLOUGHLIN BLVD
MILWAUKIE OR
97267-6735
US

IV. Provider business mailing address

793 S STONEHENGE TER
WEST LINN OR
97068-2570
US

V. Phone/Fax

Practice location:
  • Phone: 503-657-0399
  • Fax: 503-657-4903
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7444
License Number StateOR

VIII. Authorized Official

Name: DR. BRIAN REED WESTOVER
Title or Position: OWNER
Credential: D.M.D.
Phone: 503-657-0399