WEST ENDODONTIC GROUP NPI 1417284480

NPI Information

  • NPI: 1417284480
  • Provider Name: WEST ENDODONTIC GROUP
  • Classification: Dentist - 1223E0200X
  • Specialization: Endodontics
  • Entity Type: Organization
  • Doing Business As: LAKESIDE ENDODONTICS
  • Address: 1245 CHEYENNE AVE
    SUITE 104
    GRAFTON, WI
    ZIP 53024
  • Phone: (262) 377-2889

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NPI Details

WEST ENDODONTIC GROUP is an endodontics dentist in Grafton, WI. The provider is the branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. WEST ENDODONTIC GROUP NPI is 1417284480. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Lakeside Endodontics.

The provider's business location address is:

1245 CHEYENNE AVE
SUITE 104
GRAFTON, WI
ZIP 53024-323
Phone: (262) 377-2889
Fax: (262) 377-2680

The provider's authorized official is Kelly Nicole West .
The authorized official title is Owner and has the following contact phone number (262) 377-2668.

The enumeration date for this NPI number is 11/11/2009 and was last updated on 11/11/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223E0200XDentistEndodontics6129-15WISCONSINYes

What is NPI?

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This page was last updated on: 11/21/2025

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