| Organization Name: | GOLD BEACH FAMILY DENTAL INC |
| NPI Number: | 1538266713 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS WAYNE WESTFALL (PRESIDENT OWNER) |
| Mailing Address: | 94223 4th St Gold Beach |
| State: | OR US |
| Postal Code: | 97444 |
| Phone Number: | 5412477332 |
| Fax Number: | 5412479204 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 02/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 4990 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |