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Organization
GOLD BEACH FAMILY DENTAL INC
Active
Organization
GOLD BEACH FAMILY DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS WAYNE WESTFALL DMD (PRESIDENT OWNER)
(541) 247-7332
Entity
Organization
Contact information
Practice address
94223 4TH ST, GOLD BEACH, OR 97444
(541) 247-7332
(541) 247-9204
Mailing address
PO BOX 772, GOLD BEACH, OR 97444
(541) 247-7332
(541) 247-9204
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4990
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
215277
OMAP
OR
01
—
IJUP6C-00
OHP
OR
Enumeration date
09/20/2006
Last updated
02/13/2008
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