Healthcare Provider Details

I. General information

NPI: 1922355684
Provider Name (Legal Business Name): MICHAEL R WESTMAN DDS MS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2012
Last Update Date: 08/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 CHARLES ST
RACINE WI
53402-2536
US

IV. Provider business mailing address

4944 CHARLES ST
RACINE WI
53402-2536
US

V. Phone/Fax

Practice location:
  • Phone: 262-994-4229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5228015
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number5228015
License Number StateWI

VIII. Authorized Official

Name: DR. MICHAEL R WESTMAN
Title or Position: OWNER
Credential: D.D.S., M.S.
Phone: 262-994-4229