Individual provider · NPI-1
Charles Rollin Westerberg, LD Licensed Denturis
Denturist · Boise, ID
NPI number1659760684
StatusActive
Last updated in NPPESJan 14, 2015
Details
- NPI
- 1659760684
- Entity type
- Individual (NPI-1)
- Name
- Charles Rollin Westerberg
- Credential
- LD Licensed Denturis
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 14, 2015
- Last updated
- Jan 14, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122400000X | Denturist | LD-46 | ID | Yes |
Practice location
6710 W. Overland Rd.Boise, ID 83709
Phone 208-323-7790
Mailing address
6710 W Overland Rd.Boise, ID 83709
Phone 208-323-7790
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