Healthcare Provider Details

I. General information

NPI: 1972235232
Provider Name (Legal Business Name): CRISTEN D. WHITMER DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CALLE TECATE STE 206
CAMARILLO CA
93012-5286
US

IV. Provider business mailing address

4000 CALLE TECATE STE 206
CAMARILLO CA
93012-5286
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-1989
  • Fax:
Mailing address:
  • Phone: 805-379-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CRISTEN DISMUKE WHITMER
Title or Position: PRESIDENT
Credential: DDS
Phone: 805-377-1485