Healthcare Provider Details

I. General information

NPI: 1528220910
Provider Name (Legal Business Name): DANIEL CLAYTON WHITNEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 BOBCAT WAY
GREAT FALLS MT
59405
US

IV. Provider business mailing address

2511 BOBCAT WAY
GREAT FALLS MT
59405
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-4322
  • Fax: 406-771-1516
Mailing address:
  • Phone: 406-727-4322
  • Fax: 406-771-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4097
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30258
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: