MEDICARE: DR. CHAD MICHAEL WHITING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	31830	TX
2	1223G0001X	General Practice Dentistry	5904	AZ

General Provider Information

NPI Number	:	1144355629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD MICHAEL WHITING DDS

Provider Business Mailing Address
First Line	:	12171 W PARMER LN STE 101
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7362
Country	:	US
Telephone Number	:	512-528-8900
Fax Number	:	512-528-8903

Provider Business Practice Location Address
First Line	:	12171 W PARMER LN STE 101
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7362
Country	:	US
Telephone Number	:	512-528-8900
Fax Number	:	512-528-8903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	03/30/2021

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