Provider Demographics
NPI:1174592372
Name:WESTERNOFF, TRENT HOWARD (DDS DMD MD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:HOWARD
Last Name:WESTERNOFF
Suffix:
Gender:M
Credentials:DDS DMD MD
Other - Prefix:
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Mailing Address - Street 1:30190 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-363-2540
Mailing Address - Fax:949-363-3352
Practice Address - Street 1:30190 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-363-2540
Practice Address - Fax:949-363-3352
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA55703204E00000X, 122300000X
TXM0604204E00000X
MA197751223S0112X
TX220871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist