1962676916 NPI number — WESTMOORE DENTAL STUDIO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962676916 NPI number — WESTMOORE DENTAL STUDIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTMOORE DENTAL STUDIO
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:
JANET Y. HENDRICK, D.D.S.
Provider Other Organization Name Type Code:
4
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:
1962676916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11317 S WESTERN AVE
Provider Second Line Business Mailing Address:
BUILDING 500
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-692-5800
Provider Business Mailing Address Fax Number:
405-692-4501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11317 S WESTERN AVE
Provider Second Line Business Practice Location Address:
BUILDING 500
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-692-5800
Provider Business Practice Location Address Fax Number:
405-692-4501
Provider Enumeration Date:
04/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDRICK
Authorized Official First Name:
JANET
Authorized Official Middle Name:
YORK
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
405-692-5800

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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