Healthcare Provider Details

I. General information

NPI: 1750610127
Provider Name (Legal Business Name): CRISTEN DISMUKE WHITMER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 07/21/2022
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: 805-379-1988
Mailing address:
  • Phone: 805-379-1989
  • Fax: 805-379-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: