MEDICARE: DR. SIDNEY NIEL WHITING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11256	MA

General Provider Information

NPI Number	:	1598865198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIDNEY NIEL WHITING DDS

Provider Business Mailing Address
First Line	:	990 PARADISE RD
Second Line	:	STE 3B
City	:	SWAMPSCOTT
State	:	MA
Zip	:	01909-1309
Country	:	US
Telephone Number	:	781-595-0596
Fax Number	:	781-581-9115

Provider Business Practice Location Address
First Line	:	990 PARADISE RD
Second Line	:	STE 3B
City	:	SWAMPSCOTT
State	:	MA
Zip	:	01909-1309
Country	:	US
Telephone Number	:	781-595-0596
Fax Number	:	781-581-9115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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