MEDICARE: JERRY L WESTOVER DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	29935	TX

General Provider Information

NPI Number	:	1316452840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERRY L WESTOVER DDS PLLC

Provider Business Mailing Address
First Line	:	283 SKI PLEX DR
Second Line	:
City	:	SEGUIN
State	:	TX
Zip	:	78155-0473
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 HILLCROFT ST STE 303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4771
Country	:	US
Telephone Number	:	512-839-0330
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JERRY L. WESTOVER
Credential	:
Telephone Number	:	512-839-0330

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/16/2019

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