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General NPI Number Information
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NPI Number | 1609250620
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Entity Type | Organization
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Legal Business Name | WEST & EHLIS ORTHODONTIC MANAGEMENT COMPANY LLC
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 4710 AMBER VALLEY PKWY S SUITE B
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City | FARGO
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State | ND
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Zip | 58104-8694
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Country | US
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Telephone | 701-293-5300
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Fax | 701-293-3317
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Provider Business Mailing Address
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Address Line | 4710 AMBER VALLEY PKWY S SUITE B
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City | FARGO
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State | ND
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Zip | 58104-8694
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Country | US
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Telephone | 701-293-5300
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Fax | 701-293-3317
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN MARTIN WEST
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Credential | DDS
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Telephone | 701-293-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1969
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License Number State | ND
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