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General NPI Number Information
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NPI Number | 1316452840
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Entity Type | Organization
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Legal Business Name | JERRY L WESTOVER DDS PLLC
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 6510 HILLCROFT ST STE 303
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City | HOUSTON
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State | TX
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Zip | 77081-4771
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Country | US
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Telephone | 512-839-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 283 SKI PLEX DR
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City | SEGUIN
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State | TX
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Zip | 78155-0473
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERRY L. WESTOVER
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Credential |
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Telephone | 512-839-0330
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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 | 29935
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License Number State | TX
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