Provider Demographics
NPI:1871148098
Name:LAURA J WESTOVER DDS LLC
Entity type:Organization
Organization Name:LAURA J WESTOVER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-290-8422
Mailing Address - Street 1:29650 SHAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5035
Mailing Address - Country:US
Mailing Address - Phone:419-290-8422
Mailing Address - Fax:
Practice Address - Street 1:8484 MARKET ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4169
Practice Address - Country:US
Practice Address - Phone:440-266-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty