Healthcare Provider Details

I. General information

NPI: 1972950509
Provider Name (Legal Business Name): DAVID WHITING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 W 101ST AVE UNIT 300
WESTMINSTER CO
80021-3948
US

IV. Provider business mailing address

8700 W 101ST AVE UNIT 300
WESTMINSTER CO
80021-3948
US

V. Phone/Fax

Practice location:
  • Phone: 303-865-7550
  • Fax:
Mailing address:
  • Phone: 303-865-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number00204222
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: