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General NPI Number Information
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NPI Number | 1013074095
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Entity Type | Organization
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Legal Business Name | WESTNEDGE FAMILY DENTISTRY
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3907 S WESTNEDGE AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-3187
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Country | US
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Telephone | 269-345-8893
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Fax | 269-492-1710
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Provider Business Mailing Address
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Address Line | 3907 S WESTNEDGE AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-3187
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Country | US
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Telephone | 269-345-8893
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Fax | 269-492-1710
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID CHARLES SACKETT
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Credential | D.D.S
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Telephone | 269-345-8893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14741
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License Number State | MI
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