Provider Demographics
NPI:1023152204
Name:WEST, GORDON HARVEY (DDS)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:HARVEY
Last Name:WEST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W SOUTH BOULDER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2854
Mailing Address - Country:US
Mailing Address - Phone:303-665-5335
Mailing Address - Fax:303-665-0622
Practice Address - Street 1:1140 W SOUTH BOULDER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2854
Practice Address - Country:US
Practice Address - Phone:303-665-5335
Practice Address - Fax:303-665-0622
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice