Provider Demographics
NPI:1497456131
Name:JERRY L WESTOVER DDS PLLC
Entity type:Organization
Organization Name:JERRY L WESTOVER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:WESTOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-839-0330
Mailing Address - Street 1:1100 STATE PARK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-3832
Mailing Address - Country:US
Mailing Address - Phone:512-925-7545
Mailing Address - Fax:
Practice Address - Street 1:6400 HILLCROFT ST STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3107
Practice Address - Country:US
Practice Address - Phone:713-772-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERRY L WESTOVER DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty