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General NPI Number Information
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NPI Number | 1538386057
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Entity Type | Individual
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Provider Name | DANIEL RUSSELL WEST D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 4958 LAVISTA RD
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City | TUCKER
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State | GA
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Zip | 30084-4403
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Country | US
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Telephone | 770-493-8500
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Fax | 770-270-1572
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Provider Business Mailing Address
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Address Line | 4958 LAVISTA RD
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City | TUCKER
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State | GA
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Zip | 30084-4403
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Country | US
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Telephone | 770-493-8500
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Fax | 770-270-1572
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8300
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN013221
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License Number State | GA
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