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General NPI Number Information
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NPI Number | 1689680365
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Entity Type | Organization
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Legal Business Name | MARK A. WESTHOFF,D.D.S.,P.C.
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 626 W CENTENNIAL AVE
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City | CARTHAGE
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State | MO
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Zip | 64836-2846
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Country | US
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Telephone | 417-358-9006
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Fax | 417-358-3064
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Provider Business Mailing Address
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Address Line | 626 W CENTENNIAL AVE
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City | CARTHAGE
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State | MO
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Zip | 64836-2846
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Country | US
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Telephone | 417-358-9006
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Fax | 417-358-3064
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. MARK ALAN WESTHOFF
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Credential | D.D.S.
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Telephone | 417-358-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | MO14349
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License Number State | MO
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