Healthcare Provider Details

I. General information

NPI: 1770036709
Provider Name (Legal Business Name): MARK WHITING DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 SKY POINTE DR STE 100
LAS VEGAS NV
89131-4001
US

IV. Provider business mailing address

6620 SKY POINTE DR STE 100
LAS VEGAS NV
89131-4001
US

V. Phone/Fax

Practice location:
  • Phone: 702-550-8827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-329
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: