Provider Demographics
NPI:1104355791
Name:WHITESELL, SERENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:
Last Name:WHITESELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-0785
Mailing Address - Country:US
Mailing Address - Phone:605-928-3363
Mailing Address - Fax:
Practice Address - Street 1:714 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-2313
Practice Address - Country:US
Practice Address - Phone:605-928-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-094161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice