Healthcare Provider Details

I. General information

NPI: 1356098107
Provider Name (Legal Business Name): WHITNEY & DALE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12509 E MISSION AVE STE 203
SPOKANE VALLEY WA
99216-1062
US

IV. Provider business mailing address

12509 E MISSION AVE STE 203
SPOKANE VALLEY WA
99216-1062
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-6464
  • Fax: 509-924-8892
Mailing address:
  • Phone: 509-928-6464
  • Fax: 509-924-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUN MICHAEL WHITNEY
Title or Position: OWNER
Credential: DDS
Phone: 208-691-8229