Provider Demographics
NPI:1366575821
Name:WESTENFELDER, LORI ALEKSIC
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ALEKSIC
Last Name:WESTENFELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MICHELE
Other - Last Name:ALEKSIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1227 S HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4140
Mailing Address - Country:US
Mailing Address - Phone:406-728-9442
Mailing Address - Fax:
Practice Address - Street 1:1227 S HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4140
Practice Address - Country:US
Practice Address - Phone:406-728-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2013122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0112574Medicaid