MEDICARE: DR. WHITNEY CHRISTINE HUSTAD DAVIDSON 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	12242	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	904481047559	OTHER	MN	PREFERRED ONE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	97G02HU	OTHER	MN	BCBSMN
4	1858670	OTHER	MN	UNITED CONCORDIA
5	HP65362	OTHER	MN	HEALTH PARTNERS

General Provider Information

NPI Number	:	1720165905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WHITNEY CHRISTINE HUSTAD DAVIDSON DDS

Provider Business Mailing Address
First Line	:	906 WOODLAND AVE
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55812-1113
Country	:	US
Telephone Number	:	218-606-1040
Fax Number	:	218-606-1060

Provider Business Practice Location Address
First Line	:	906 WOODLAND AVE
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55812-1113
Country	:	US
Telephone Number	:	218-606-1040
Fax Number	:	218-606-1060

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/12/2016

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