Healthcare Provider Details

I. General information

NPI: 1255405551
Provider Name (Legal Business Name): THOMAS C WESTRICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCDILL AVENUE CENTRAL WISCONSIN ENDODONTICS
STEVENS POINT WI
54481
US

IV. Provider business mailing address

100 MCDILL AVENUE CENTRAL WISCONSIN ENDODONTICS
STEVENS POINT WI
54481
US

V. Phone/Fax

Practice location:
  • Phone: 715-345-7740
  • Fax: 715-345-7742
Mailing address:
  • Phone: 715-345-7740
  • Fax: 715-345-7742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5041015
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: