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General NPI Number Information
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NPI Number | 1225254709
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Entity Type | Organization
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Legal Business Name | DAVID WESTERBERG D.D.S. CORPORATION
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2131 ELKS DR STE 104
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5571
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Country | US
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Telephone | 909-882-1211
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Fax | 909-882-7006
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Provider Business Mailing Address
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Address Line | 2131 ELKS DR STE 104
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5571
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Country | US
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Telephone | 909-882-1211
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Fax | 909-882-7006
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Authorized Official
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Title or Position | DENTIST
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Name | DAVID G WESTERBERG
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Credential | D.D.S.
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Telephone | 909-882-1211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36121
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License Number State | CA
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