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General NPI Number Information
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NPI Number | 1487147914
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Entity Type | Individual
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Provider Name | ERIC WHITING
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Gender | Male
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Dates
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Enumeration Date | 06/09/2018
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Last Update Date | 08/09/2020
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Provider Practice Location Address
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Address Line | 2618 W 7800 S STE 100
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City | WEST JORDAN
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State | UT
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Zip | 84088-4212
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Country | US
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Telephone | 801-380-5279
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Fax |
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Provider Business Mailing Address
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Address Line | 2568 N LAKE MOUNTAIN RD
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-4091
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Country | US
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Telephone | 801-380-5279
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11722037-9922
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License Number State | UT
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