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General NPI Number Information
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NPI Number | 1891118428
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Entity Type | Organization
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Legal Business Name | MICHAEL J. WHITTED DDS PC
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 1950 GYORR AVE
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-2289
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Country | US
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Telephone | 847-695-5100
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Fax | 847-695-5180
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Provider Business Mailing Address
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Address Line | 1950 GYORR AVE
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-2289
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Country | US
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Telephone | 847-695-5100
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Fax | 847-695-5180
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MICHAEL WHITTED
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Credential | DDS
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Telephone | 847-695-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.027885
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 319.018217
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.026132
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License Number State | IL
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