Healthcare Provider Details

I. General information

NPI: 1740244946
Provider Name (Legal Business Name): STEVEN DARCEY WHITTEMORE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 73RD ST SUITE 10
WINDSOR HEIGHTS IA
50311-1321
US

IV. Provider business mailing address

4535 ZILKER DR
PLEASANT HILL IA
50327-0923
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-1298
  • Fax:
Mailing address:
  • Phone: 515-262-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number08228
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: