# DR. BROCK B WESTOVER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1700949518
- **Gender:** Man
- **Credential:** D.D.S., M.ED.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | 2516-89 | MS | — |
| 1223P0700X | Prosthodontics | 61337 | CA | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 11/12/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 72-1343206 | T.I.N. | MS |