Healthcare Provider Details

I. General information

NPI: 1568490456
Provider Name (Legal Business Name): DAVID A. WHISTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD PLAZA 1, LOBBY LEVEL
FALLS CHURCH VA
22042-2325
US

IV. Provider business mailing address

6400 ARLINGTON BLVD PLAZA 1, LOBBY LEVEL
FALLS CHURCH VA
22042-2325
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-6500
  • Fax: 703-534-0039
Mailing address:
  • Phone: 703-534-6500
  • Fax: 703-534-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401003444
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: