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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