1003948027 NPI number — ARTHUR WESTPHAL DMD AND BRUCE STOLLE DMD PC

Table of content: (NPI 1003948027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003948027 NPI number — ARTHUR WESTPHAL DMD AND BRUCE STOLLE DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHUR WESTPHAL DMD AND BRUCE STOLLE DMD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAWTHORN DENTAL - ST. CHARLES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003948027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 S OLD HIGHWAY 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63303-5622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-928-8400
Provider Business Mailing Address Fax Number:
636-928-0480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 S OLD HIGHWAY 94
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63303-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-928-8400
Provider Business Practice Location Address Fax Number:
636-928-0480
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STOLLE
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER DENTIST
Authorized Official Telephone Number:
636-928-8400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)