Healthcare Provider Details

I. General information

NPI: 1144386160
Provider Name (Legal Business Name): DAVID EARLE WHITEHEAD JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR STREET SUITE 1018
HARTFORD CT
06106
US

IV. Provider business mailing address

85 SEYMOUR STREET SUITE 1018
HARTFORD CT
06106
US

V. Phone/Fax

Practice location:
  • Phone: 860-251-6999
  • Fax: 860-251-6997
Mailing address:
  • Phone: 860-251-6999
  • Fax: 860-251-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7277
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: