Provider Demographics
NPI:1003061250
Name:FLORENCE DENTAL PLLC
Entity Type:Organization
Organization Name:FLORENCE DENTAL PLLC
Other - Org Name:FLORENCE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-868-3384
Mailing Address - Street 1:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-1319
Mailing Address - Country:US
Mailing Address - Phone:520-868-3384
Mailing Address - Fax:
Practice Address - Street 1:46 E 11TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232
Practice Address - Country:US
Practice Address - Phone:520-868-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7646261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental